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LAOCOON. 

I lie simul manibus tendit divellere nodos, 
Clamores simul horrendos ad sidera tollit." 

Virgil, Mneid, Lib. ll. 

The knotted coils he strains to tear apart, 
Filling the air and heaven with horrid cries. 






To 

$x. Qltxm&tt f ♦ ®. £&*»*, 

Professor of the Medical and Surgical Diseases of Women and the 

Diseases of Children, in the 

Long Island College Hospital, Brooklyn, N. Y., 

THIS LITTLE WORK IS DEDICATED, 

as a mark of the high esteem, 

both as regards his scientific attainments, 

untiring energy, and the largeness of his heart, in which he is 

held by 

his old pupil and sincere admirer, 

THE AUTHOR. 



PREFACE. 



The idea of writing this little work was first suggested to 
me by the numerous letters received from physicians at 
home and abroad, asking for information on various points 
connected with the symptomatology, prognosis and treat- 
ment of the various "habits." While manifesting an 
earnest desire to become acquainted with the main features 
of the conditions in question, many presented a lamentable 
ignorance of the simple facts relating to them. 

These facts I have endeavored to present in as compre- 
hensive, yet concise, a form as possible. But little space 
has been devoted to the study of the hashisch habit, owing 
to its rarity in this country. 

The statements as to the dangers and peculiarities of 
these conditions, aside from what I have myself observed, 
are based upon the literature of the subject, and the letters 
of nearly a thousand correspondents in various parts of the 
world, to whom I take this occasion for returning my 
hearty thanks. 

igi West Tenth Street, 

New York City. 



" After my death I earnestly entreat that a full and unqualified narrative of my 
wretchedness, and of its guilty cause, may be made public, that at least some little 
good may be effected by the direful example." — Coleridge. 

A curse that is daily spreading, that is daily rejoicing in an 
increased number of victims, that entangles in its hideous 
meshes such great men as Coleridge, De Quincey, William 
Blair, Robert Hall, John Randolph, and William Wilberforce, 
besides thousands of others whose vice is unknown, should 
demand of us a searching and scientific examination. 

As an illustration of the enormous increase of the use of 
opium and morphia in the United States, the following statis- 
tics have a painful interest, and it must be remembered that 
this is no exceptional case. In one of our large cities, contain- 
ing, twenty-five years ago, a population of 57,000, the sales of 
opium and morphia reached 350 pounds and 375 ounces, 
respectively, or about 43 grains of opium and 3 grains of mor- 
phia yearly for each individual, if the consumption was 
averaged. The population is now 91,000, and 3500 pounds of 
opium and 5500 ounces of morphia are sold annually. While 
the population has increased 59 per cent., the sale of opium 
has increased 900 per cent., and morphia 1100, or an average 
of 206 grains of opium and 24 grains of morphia to every in- 
habitant. But there are additional sales of from 400,000 to 
500,000 pills of morphia, which would give us 170 ounces more 
of the drug. One-fourth of the opium sold is consumed in its 
natural state, and three-fourths are made into opiates, the 
principal one being laudanum. 

The following is official from the New York Custom House : — 



Imports of opium 


into the United States for ten fiscal years, 


ending June 30th :- 






1871, 


315,121 lbs. 


$1,926,915 


1872, 


416,864 " 


2,107,341 


1873, 


319^34 " 


1,978,502 


1874, 


395>9°9 " 


2,540,228 


i875> 


132,541 " 


939,553 


1876, 


388,311 " 


1,805,906 


1877, 


349» 22 3 " 


1,788,347 


1878, 


43o,95o " 


1,874,815 


1879, 


405,957 M 


1,809,696 


1880. 


533,451 " 


2,786,606 



Facts like these must, we think, arouse attention. They 
show a fearful drift. There is a worse form of intemperance 
than that which comes from bad liquor, although the choice 
would seem to be between the devil and the deep sea : 

" And in the lowest depth, a lower deep, 
Still threatening to devour us, opens wide." 



CONTENTS. 



CHAPTER I. page 

The Opium and Morphine Habits. Formation ; General 

Symptoms 17-26 

CHAPTER II. 
Preparations Employed. Manner of Using 27-33 

CHAPTER III. 
General Symptoms Analyzed and Classified 34-45 

CHAPTER IV. 

General Symptoms Analyzed and Classified — Concluded. 46-70 

CHAPTER V. 

Accidents Incident to the Subcutaneous Use of Mor- 
phia 71-105 

CHAPTER VI. 

The Treatment of the Opium and Morphia Habits. 

General Considerations 106-129 

CHAPTER VII. 

Agents Used in the Treatment of the Opium and Mor- 
phia Habits 130-148 

CHAPTER VIII. 
The Continued Use of Chloral 149-164 

CHAPTER IX. 

Effects of Chloral on the Different Systems and Appa- 
ratuses 165-179 

7 



8 CONTENTS. 

CHAPTER X. page 

Effects of Chloral on the Different Systems and Appa- 
ratuses — Concluded 180-199 

CHAPTER XI. 
Symptoms of Abstinence from Chloral — Treatment 200-205 

CHAPTER XII. 
The Hashisch Habit 206-218 

CHAPTER XIII. 
Conclusion 219-221 



Drugs That Enslave. 



the 

OPIUM, MORPHINE, 

CHLORAL AND HASHISCH HABITS. 









f 








- 






BY 


H 


. H. KANE, 

NEW YORK CITY 


M. 


D., 
















• 














" They are drunken, 
drink." — Isaiah. 


but 


not with wine; they 


stagger, but 


not 


with 


strong 



*' What warre so cruelle, and what siege so sore, 
To bring the sowle into captivitie, 
As that fierce appetite doth fain supplie !" 



/3i I % 

PHILADELPHIA: 

PRESLEY BLAKISTON, 

1012 WALNUT STREET. 
l88l. 



i 






Entered, according to Act of Congress, in the year 1881, by 

PRESLEY BLAKISTON, 

In the office of the Librarian of Congress, at Washington, D. C. 



Press of WM. F. FELL & CO., 

1220-1224 Sansom Street. 



THE OPIUM AND MORPHINE HABITS. 



CHAPTER I. 

THEIR PATHOLOGY. 

A higher degree of civilization, bringing with it in- 
creased mental development among all classes, increased 
cares, duties and shocks, seems to have caused the habitual 
use of narcotics, once a comparatively rare vice among 
Christian nations, to have become alarmingly common. 

Increase in mental strain, hot-house development of the 
passions, lessened physical labor and increased mental 
work, have been gradually giving us bodies in which the 
nervous element largely preponderates. Persons who may 
be classed under the head of " nervous temperament " are 
daily on the increase. 

Diseases are to-day as different from diseases of a century 
ago as is their treatment. While the average individual 
now does more mental work in an hour than did our an- 
cestors in six hours, we are not one-sixth as well able to 
bear the intellectual strain as they were. 

Nine-tenths of us neither eat, sleep, exercise, bathe, or 
procreate in a proper way. It is all hurry and turmoil ; 
little rest and much care. Generation by generation our 
physical natures are changing, and in the children of each 
succeeding generation we see the preponderance of the 

17 



18 THE OPIUM HABIT. 

nervous element ; a gradual evolution of that or those 
peculiarities most prominently brought forth by the exi- 
gencies of the individual and national life of a people. 

Finding pain, "nervousness" and hysteria constantly 
claiming his attention, and that nothing relieves them so 
well as opium, or its alkaloid morphia, which is six times the 
parent strength, the physician resorts to their use more and 
more freely, expecting as soon as the more distressing 
symptoms pass away to pursue another and more perman- 
ent plan of treatment. The patient, however, having once 
experienced relief, insists upon the further use of the drug, 
sometimes feigns illness, in order to procure it, finally 
obtains some herself, and in guilty secrecy drifts rapidly 
into the habit. 

Some physicians are weak enough to place the means of 
gratifying this morbid appetite directly in the hands of the 
patient. This is more especially the case since the hypo- 
dermic use of the drug has become common. So magical 
is the effect of this mode of administration, so rapid and 
forcible the action of the drug, that many persons will not 
rest content until they possess and are using the instrument. 
As the affections for which opium and morphine are most 
commonly used are chiefly found in neurasthenic patients, 
and as these patients are ever ready to indulge in excesses, 
in both stimulants and narcotics, it is not surprising that 
the number of victims to this slavery is daily on the 
increase, both in town and country. Moreover, nervous 
affections are on the increase : pain without any very 
apparent cause, nervousness from the most trivial things. 
Neuralgias are more common. Insanity also. Suicide is 
daily more frequent. 

Those not acquainted with the truth in this matter will 
be surprised to learn that there are to-day thousands of 



ITS PATHOLOGY. 19 

educated and respectable people in all countries and 
among all classes, confirmed habitues; slaves to a habit 
that is more exacting than the hardest taskmaster, that 
they loathe beyond all else, and yet that binds them in 
chains that they are wholly unable to break. 

Everything must give way to this vice. Business is 
neglected or but imperfectly performed ; family ties are 
sundered ; hope, ambition, happiness, self-respect are 
meaningless words ; the one thing that fills the mind is 
the gratification of this passion, which they loathe, but 
from which they cannot break. 

Thus from day to day, week to week, year to year, they 
go on ; not living — simply existing. Each day, each 
hour, each minute binds them more firmly, until at last 
they feel their own inability to cope with the demon that 
has overpowered them, and abandon themselves, hope- 
lessly, listlessly, to the vice. Repentance comes too late. 
The momentary pleasure, the short period of excitement, 
the hour of vivacity bears fruit a thousand-fold ; fruit, the 
bitter taste of which must last them a lifetime. That 
which at first gave them pleasure has now become the 
veriest tyrant, enforcing long hours of pain and anguish, 
gloom and despondency. They do not continue its use 
because it gives them pleasure, but simply because it is the 
only thing that, in increasing doses, can save them from 
the torment it has itself imposed ; because without it they 
are sunk into a living hell. The mind is incapable of 
healthy action, the temper is decidedly aggravated, the 
person taking offence at and scolding furiously about 
things that in health, or while under the influence of opium, 
would excite no comment. They suffer from terrible 
nightmares. They are constantly on the edge of imagi- 
nary precipices, or falling, falling down dizzy heights. 



20 THE OPIUM HABIT. 

Sleep, if had at all, is broken, unsatisfactory and fraught 
with the most frightful and torturing dreams, into the warp 
and woof of which are constantly woven the most horrible 
sights. Now they are the victims of some terrible accident, 
again, they are hurried on by some malignant persecution. 
They fancy that they are drowning, that they are being 
burned at the stake, inhaling the sickening odor of their 
own burning flesh, feeling it peel from their aching bones. 
Then comes the awakening with a start or scream. The 
gradual realization that these things are not real ; the cold 
sweat ; the trembling of the limbs ; the sense of utter ex- 
haustion from which they sink into sleep once more, to live 
again the agonizing scenes of their diseased imagination ; 
waking and sleeping and counting the minutes as days, the 
hours as years, until morning finally comes. 

Nor are the torments of day much less than those of the 
night. The stomach rebels ; nausea is persistent and 
distressing ; saliva gathers in the- mouth ; there is sinking 
at the pit of the stomach ; severe cramps of the intestines ; 
the lips and throat are dry and parched ; the tongue 
swollen. A dry, irritating cough sets in. Pains girdle the 
body and shoot with agonizing intensity down the limbs 
and into the face. The muscular system fails ; locomotion 
is attended with difficulty ; the sufferer staggers like a 
drunkard ; the muscles of the face and eyelids twitch ; the 
hands shake so that a glass falls from them, and it is im- 
possible to pick up a small object. The circulation is 
affected ; flushing and chilliness alternate ; the eyes are 
dry, and feel as though filled with sand. 'The mind wan- 
ders ; delirium supervenes ; diarrhoea and vomiting set in, 
and sometimes collapse, and a more pitiable object can 
nowhere be found. 

It is at this time that the sufferer, tortured beyond all 



ITS PATHOLOGY. 21 

power of endurance, would sell body, soul, anything > to 
obtain that drug which, while it gives no fresh pleasure, 
removes these ill effects, as if by magic. 

A dose is taken. A pleasant sense of warmth pervades 
the body ; the mind clears, the hands become steady, the 
gait natural, the pains vanish, the nausea and diarrhoea 
cease, and existence becomes again bearable. 

Each dose must be a little larger than the preceding, in 
order to obtain the desired effect. In some cases the in- 
crease is very slow, but these are rare exceptions. Rarer 
still are those instances where no increase is necessary. 

I have here portrayed the suffering of one who has been 
using the drug for a considerable time, or for a shorter 
time in large doses. The chains, though not at first galling, 
are nevertheless there, and each succeeding dose rivets 
them tighter. 

There are certain rare cases where opium seems, instead 
of doing harm, to be of positive benefit to the person using 
it. Dr. Joseph Parrish, a veteran observer of these cases, 
wrote me that he had known of several. One is related 
by Dr. Golding Bird.* A lady, probably hysterical, took 
morphia for the relief of paroxysmal pain in the loins. 
She had been taking it for several years. For the past two 
years she had increased the dose to ten grains, taken three 
times daily. There were no obvious ill effects ; functions 
were properly carried on, the appetite was good, and there 
was no known organic disease. 

The therapeutics of any epoch is strictly in conformity 
with the most prominent disease or symptom of the people 
upon whom the physicians practice. This is true of whole 
countries and sections of countries as well as of times. 

Formerly, when it was common for physicians to pre- 

* Practitioner, Vol. vi, p. 149. 



22 THE OPIUM HABIT. 

scribe opium, it was this drug that the people ate. As 
morphine came into fashion, it was prescribed largely by 
the profession and the persons forming the habit at that 
time, as a rule, ate morphine. Habitues of the opium 
epoch also resorted to it, finding it so much more powerful 
than the crude drug, so much less bulky, and it did away 
with the necessity for calling forth a response to opium 
from the shattered system by resort to alcoholic stimulants. 
At the time in which De Quincey, Coleridge, and Southey 
lived, the people and the profession knew little of the opium 
habit, save among foreign nations ; the habitues were few in 
number, and, as a consequence, when De Quincey' s article 
appeared, it created a most decided impression on the public 
mind ; an impression not yet effaced, and one which bore 
with it an incalculable amount of harm. Men and women 
who had never heard of such a thing, stimulated by curios- 
ity, their minds filled with the vivid pictures of a state of 
dreamy bliss, a feeling of full content with the world and 
all about, tried the experiment, gradually wound them- 
selves in the silken meshes of the fascinating net, which 
only too soon proved too strong to admit of breaking. 

There is no question in my mind that, in writing his 
" Confessions," De Quincey left a large debit on the side 
of truth, and handed down to succeeding generations a 
mass of ingenious lies ; more pleasantly the fiction, vapor- 
izing from a laudanum- soaked brain. He must needs seek 
some justification for his life of willful misery, for the blasted 
hopes, ambitions and prospects of what might have been a 
noble career, and he offered the dream life, the fuller 
development of benevolence, and the many pleasures so 
fantastically portrayed, as a justification, in part at least, 
for his sin. 

Nor does the final confession of the intense pain, the 



ITS PATHOLOGY. 23 

abject misery, the tottering of the mind, the crumbling of 
the reasoning and will power, and the ever attendant and 
impenetrable gloom of a living hell, serve to fully counter- 
act the baneful effects of the portrayal of the pleasures of 
opium. The reader, confident of his ability to stop short 
of the ever-shifting line that divides the happiness from the 
misery, is in no wise deterred from trying the danger-fraught 
experiment. I know of several patients who began the 
use of opium simply from reading this most pernicious 
book. 

Upon persons living in temperate and cold climates this 
drug does not have any such effect, with reference to the 
subject matter of dreams, as upon Orientals. Indolent, 
over-fed, and by reason of their mode of life, religious 
associations and habits of thought, fancifully imaginative, 
it is not surprising that they should enjoy, while under the 
influence of the drug, grotesque, and to them, pleasant, 
dreams. Did the opium cause dreams foreign to the pic- 
ture daily conjured by their fertile imaginations, it would 
indeed be more surprising. That it does not produce such 
effects on our plain, work-a-day people is not to be won- 
dered at. 

As I have already said, the preparation of the drug used 
and the manner of using it in any epoch has been exactly 
in consonance with the practice of physicians at that time. 
Of late years physicians are becoming more and more 
addicted to the subcutaneous use of morphine, and as a 
consequence, the number of persons who habitually use 
the drug in this way is daily on the increase. Eight- 
tenths of those from whom I hear and of those who come 
to me for treatment are using the drug subcutaneously. 

Dr. Charles Warrington Earle, of Chicago, in a very able 



24 THE OPIUM HABIT. 

and well written little pamphlet,* is of the opinion that the 
majority of habitues do not use the drug in this way. In reply 
I can only reassert my opinion just expressed, and must say 
that the tendency of these patients to falsify, and their 
delicacy in disclosing their manner of using the drug to 
the druggists from whom they obtain their supply, must 
be taken into consideration. Dr. Earle bases his conclu- 
sions on 235 cases, the histories of which have chiefly been 
obtained from druggists. 

Be it understood, however, that I do not maintain that 
the majority of opium and morphine takers use the latter 
drug by the hypodermic syringe. I simply say that in 
my experience this manner of using the drug is largely on 
the increase among habitues, and will go on increasing 
from year to year, in the same manner that morphine is 
rapidly replacing opium in the practice of physicians. 
This is well shown by one of Dr. Earle' s carefully prepared 
tables : — 

KIND OF NARCOTIC. 

Morphia was used in . . .120 cases. 

Tincture of opium was used in 30 

Paregoric " " . . 5 

McMunn's elixir " " . . 2 

Gum opium " " . -5° 

Dover's powders " " . . 1 

Unknown " " . . 27 

2 35 
The age at which this habit is most common is from 
thirty to forty, both in males and females. The following 
table, which, as Dr. Earle states, is only approximative, is 
of interest in this connection : — 

* " The Opium Habit; " reprint from the Chicago Medical Review, October and 
November 5th, 1880. 



f 



ITS PATHOLOGY. 25 

Males — 

From 20 to 30 years ..... 5 

From 30 to 40 years . . . . . 19 

From 40 to 50 years . . . . .11 

From 50 to 60 years . . . . 7 

From 60 to 70 years .... - 1 

From 70 to 80 years . 1 

Unknown age . . . . . . .22 

Total 66 

Females — 

From 10 to 20 years ..... 2 

From 20 to 30 years . . . . . 18 

From 30 to 40 years . . . . -39 

From 40 to 50 years . . . . . 22 

From 50 to 60 years . . . . .14 

From 60 to 70 years ..... 4 
One-third entire number prostitutes, probably 

from 15 to 50 . . . . . -56 

Unknown age . . * . . . 14 

Total . . . . . . .169 



Females are more frequent victims than males, in the 
proportion of three to one. This is undoubtedly due to 
the fact that women more often than men are afflicted with 
diseases of a nervous character, in which narcotic remedies 
are used sometimes for a long period, and also to the fact 
that in some instances it is used by them in place of alco- 
holic stimulants, its effects being less noticeable and 
degrading, although none the less intoxicating. 

Both males and females are usually of the higher orders, 
in point of intellect and culture. In some cases business 
failure or family trouble has been the incentive for a resort 
to the use of the drug. In some instances the fact that 
opium eating had ruined the mental powers of the victim, 



26 THE OPIUM HABIT. 

or caused him to be careless or negligent of his home rela- 
tions, has led to the business failure, or the sundering of 
family ties. The majority of patients come from the 
middle classes, those people who are continually toiling 
and worrying in the almost ceaseless endeavor to " keep 
up appearances." 

The fact that most opium eaters are married, widow or 
widower, is probably explainable on the ground that in 
the majority of instances, the patients among whom it is 
most common are at just the age when marriage has taken 
place. In some the habit is contracted before, in others 
after marriage. 

I knew of one example where the wife, a young woman 
of eighteen, contracted the habit of using the drug subcu- 
taneously, through the carelessness of her physician. The 
husband began then to use it himself, and to-day the two 
are separated, the wife partially insane, the husband a con- 
firmed habitue and also an alcoholic drunkard. One who 
sees much of this disease meets with some very sad cases. 



PREPARATIONS EMPLOYED. 27 

CHAPTER II. 

PREPARATIONS EMPLOYED. MANNER OF USING. 

The following are the various preparations used by 
opium and morphia takers — 

Crude Opium. — Variable in strength. 

Tincture of Opium, Laudanum. — i grain of opium to 
every 25 drops, or 1 grain of opium to every 13 
measured drops, minims. 

Tincture of opium, Camphorated (Paregoric) . — 1 grain to 
the ounce, or 480 drops. 

McMunri s Elixir. — Same strength as laudanum. 

Dover' 's Powder. — 1 grain of opium and 1 grain of ipe- 
cac to every 10 grains of the powder. 

Sulphate of Morphia. \ Sa ' tS . of °P iul ?' I %f* °! either 

Acetate of Morphia. \ b ? n S. eC l ual t0 about 6 S rams 
r ) of opium. 

Laudanum was De Quincey's favorite. He avers that he 
has taken as high as 8000 drops in the course of twenty- 
four hours. Coleridge is credited with having taken more. 
A patient, a lady, whom I saw in consultation with Dr. 
Brennan, of this city, took a half pint every morning. 
Without it she was totally unfit to converse or to be seen. 
Many of the old fashioned habitues use the gum opium, 
but few, paregoric, and a less number still, Dover's pow- 
der. In order to get a sufficient amount of opium for the 
average user, from Dover's powder, the ipecac, which is 
present in equal amount, would produce nausea, and offer 
a further bar to its employment. Pulverized opium and 
extract of opium have been used in the form of supposito- 
ries. This was the case with one of my patients, a gentle- 



28 



THE OPIUM HABIT. 



man suffering from chronic inflammation of the bladder ; 
after a time he abandoned the opium, using in its stead 
morphia, in gradually increasing doses. 

I have already given Dr. Earle's table as to the relative 
frequency with which the different preparations are used. 
I here append his table of quantities. Of this and the 
preparation sold, druggists from whom he obtained his 
statistics would be able to judge with a reasonable degree 
of accuracy. 

QUANTITY. 

Morphia — 



21 persons use from i to 


3 grains each day 


17 " " 3 to 


6 


12 " " 6 to 


10 " - " 


10 " " 10 to 


J 5 


12 " " 15 to 


20 <( " 


7 " }4 a drachm 




6 " 1 drachm 




20 " 1 bottle per 


week. 


5 " 2 : " 


a 


1 " 11 bottles each month. 


Tr. Opium — 




15 persons use 1 drachm each day. 


4 " 3 


a 


7 4 " 


iC 


12 " 1 ounce 


a 


4 " 2 " 


a 


1 3 " 


a 


1 4 " 


a 


G^w Opium — 




3 persons use 10 grains each day. 


5 " 20 " 


a 


9 " y 2 drachm 


a 


12 " 1 


cc 


4 " 2 " 


a 


2 " 3 


cc 


1 " 4 


cc 



METHOD OF USING. 2D 

Morphia is used either by the mouth, rectum or hypo- 
dermically. I know of a curious case, to be detailed 
more fully at a subsequent time, where the patient, a young 
lady, took morphine first subcutaneously, then by the 
rectum, and finally by the mouth. 

I am of the opinion that morphia, when continuously 
used, works more harm when taken by the mouth than 
when taken subcutaneously. Moreover, that the habit is 
more difficult to break, and relapses more prone to occur, 
in the former than in the latter class of cases. Opium or 
morphine by the mouth, after a time, exercises a directly 
paralyzing and anaesthetic effect upon the mucous membrane 
of the alimentary canal, and gives rise to hepatic derange- 
ment and sometimes serious disease. The subcutaneous 
injection of morphia undoubtedly exercises a baneful effect 
upon the same surfaces and organs, but not so directly as 
when taken by the mouth. 

Among the Eastern nations opium is used chiefly by 
smoking. As this is rarely seen in this country, save 
among people from those countries, it does not especially 
concern us. Moreover, a full account of these practices 
may be found in books of travel and other treatises upon 
that special branch of the subject. 

To Dr. Alexander Wood, of Edinburgh, belongs the 
credit of first discovering and practically applying the 
hypodermic syringe to the treatment of painful affections, 
more especially neuralgias. Drs. Isaac E. Taylor and 
Washington, of this city, claim to have used it in this 
country in 1839, while Wood's discovery was made in 
1843, an d his first article appeared in 1855. Wood's in- 
strument was first brought to this country in 1856, by Prof. 
Fordyce Barker, of this city. Then comparatively unknown, 
it is now in the possession of almost every physician in the 



30 ' THE OPIUM HABIT. 

world. In my work upon the hypodermic use of morphia* 
I made, in the preface, the following statement, the belief 
in which has since been strengthened : " There is no pro- 
ceeding in medicine that has become so rapidly popular ; 
no method of allaying pain so prompt in its action and 
permanent in its effect ; no plan of medication that has 
been so carelessly used and thoroughly abused ; and no 
therapeutic discovery that has been so great a blessing and 
so great a curse to mankind, as the hypodermic injection 
of morphia. " 

The danger of forming the habit from the use of the 
drug in this way is undoubted. Correspondents, physi- 
cians from all parts of this country, England and France, 
assert this and detail cases. Levensteinf gives many in- 
stances in Germany, and Dr. Loose, of Bremen, sends me 
the report of an able paper read by him before a medical 
society, wherein he cites cases, deplores the rapid spread 
of the practice, and advises special legislation upon the 
subject. He remarks for that country what Dr. J. B. 
Mattison, myself and others have noted in the United 
States, i. e., that many of the victims are members of the 
medical profession, in good standing. One hundred and 
thirty-one physicians report to me one hundred and eighty- 
four cases of the morphia habit, in all of which it was 
contracted by the use of the hypodermic syringe. 

The largest amount taken in the twenty-four hours by 
this method is reported to me by Dr. W. F. MciVllister, 
of the Quarantine Office, San Francisco, California: "A 
physician, resident in this city, contracted dysentery in 
Shanghai, China, in the summer of 1873. Morphia was 
used hypodermically, and he drifted into the habit of using 

* " The Hypodermic Injection of Morphia. Its History, Advantages and Dangers." 
N. Y., 1880. 
f" Morbid Craving for Morphia," London, 1878. 



METHOD OF USING. 
Fig. i. 



31 




Fig. i. — Hypodermic Syringe. Glass cylinder with metal casing. Indexed 
on glass. 



Fig. 2. 




Fig. 2. — Plain Glass Syringe, with needle. Index on stem. 



Fig. 3- 




Fig. 3. — Plain Metal Syringe, graduated on stem. 



Fig. 4. 




Fig. 4. — Plain Metallic Syringe, graduated on stem, with a cap for securely 
closing needle end of barrel, and a device by which needle can be 
carried in hollow stem. This is an excellent instrument. All 
those here shown were made by Codman & Shurtleff, of Boston, 
and are durable, accurate and easily cleaned. 



32 THE OPIUM HABIT. 

the drug in this way himself; the habit resulting in his death 
in 1878. I was called to see him professionally in 1875. ^e 
was at that time residing in Hong Kong, China. He was 
consuming each day seventy -two grains of the sulphate of 
morphia in three doses : twenty-four grains to the dose. 
This he continued to do until the day of his death. ' ' 

Prof. T. Gaillard Thomas, of this city, relates to me two 
fatal cases, in young persons, death being due to extreme 
exhaustion, dependent on imperfect nutrition and a grad- 
ual depression of the nervous and circulatory systems. 

In consequence of the skepticism evinced by some phy- 
sicians as to the danger of contracting the habit in this 
way, I feel myself called upon to urge upon them the 
utmost care in the use of this instrument, especially in the 
case of neurasthenic patients. I have had so many de- 
plorable cases of this kind brought to my notice, either as 
patients or through correspondence, that I cannot help but 
feel that this matter is one of great importance, and worthy 
of more attention and care than is usually given it. 

I have already spoken of the two ways in which the 
opium or morphia habit is formed. A patient of a nervous 
temperament, suffering from some painful or spasmodic 
disease, is attended by a physician, who administers one of 
these drugs, by the mouth, rectum, or subcutaneously. The 
relief to suffering is magical, and persists so long as the 
effect of the drug lasts. With a return of the pain comes 
.the natural desire to have it relieved, and as the narcotics just 
spoken of have been found especially efficacious the patient 
desires its repetition. This may go on for weeks and 
months, until the disease, of which the pain was but a symp- 
tom, is cured, or it may never be cured. At any rate, the 
patient awakes to the knowledge that he must have his nar- 
cotic. Life without it is unbearable, and instead of 



METHOD OF USING. 33 

putting forth an extreme effort of the will, as is done by 
some, and then and there abandoning its use, the majority 
allow themselves to drift into this habit of daily intoxica- 
tion with opium. The majority of habitues first use the 
drug for the relief of pain, and then find themselves unable 
to break loose from it. Some seem to be so constituted 
that a single or a few doses of drugs of this nature light up 
in them an irresistible desire to continue their use. There 
seems to be a morbid craving for something, exactly what 
is not known, until the narcotic is tried, when this mor- 
bid appetite is satisfied and fixed, and becomes the typical 
" morbid craving for morphia." It will be dipsomania, 
morphia-mania, chloral-mania, hasheesh-mania, according 
as the one or other drug is presented to the patient in the 
condition of craving. Some persons are undoubtedly born 
with, and some acquire, this craving for some narcotic or 
stimulant. 

A person knowing this fact can readily see how like 
putting a match to gunpowder it is to give these people 
opium or morphine in any form, and how inevitably the 
reading such a book as that of De Quincey's would create 
a longing and open the way to a road that has a certain 
ending in a life's bondage. Such as these are to be pitied, 
and deserve the kindest treatment and the most judicious 
care. They are like a person who has lost a limb, or is suffer- 
ing from a cancer. In the one instance they lack a certain 
something that should be there, and which is necessary to the 
free, full and proper enjoyment of life; in the other case — 
the acquired tendency or craving — they have a pernicious 
addition to the system that threatens them with death. 

Pity, then, rather than blame, at the same time using 
every legitimate means to break up both the habit and the 
tendency. 



34 THE OPIUM HABIT. 

CHAPTER III. 

GENERAL SYMPTOMS CLASSIFIED AND ANALYZED. 

I am of the opinion that a clearer and consequently 
more thorough understanding of this part of the subject 
can be obtained by classing the various effects of the con- 
tinued use of morphine or opium under the headings of 
the different systems and apparatuses, and have, therefore, 
adopted this method of presenting these matters to the 
reader. 

THE DIGESTIVE APPARATUS. 
{Stomach, Liver and Bowels.) 

The first effect of opium or its alkaloid morphia on the 
stomach is, in the majority of instances, to increase the 
appetite and cause a pleasant sensation of warmth and a 
feeling of general contentment. After a time, however, 
especially if the drug is taken by the mouth, the appetite 
is materially impaired, the bowels become constipated, 
there is a sensation of sinking at the pit of the stomach, 
the circulation through the liver is interfered with, a 
catarrhal inflammation of the small intestine and stomach 
supervenes, the opening of the bile duct is partially ob- 
structed by the swollen mucous membrane, and the result 
is a more or less decided staining of the skin with the 
biliary coloring matter. This is due, in part, to interfer- 
ence with the . cells in the proper performance of their 
functions, undoubtedly through the medium of the nerves 
passing to them. At the same time, the gastric juice is 
diminished in amount and lessened in strength, as is also the 
case regarding the intestinal and pancreatic secretions, the 



GENERAL SYMPTOMS ANALYZED. 35 

digestion of food is imperfectly performed, and in conse- 
quence, a condition of malnutrition results, showing itself 
in wasting of the muscles and loss of the fatty tissue be- 
neath the skin, especially of the face, breast and abdomen. 
As the gastric catarrh increases, nausea and finally vomit- 
ing ensue, still further debilitating the patient. Derange- 
ments of the stomach, liver and bowels are much more 
common among those who use the drug by the mouth. I 
have, however, seen patients who, while using morphia 
hypodermically, have suffered intensely with jaundice, 
catarrh of the stomach, nausea and vomiting. When these 
disorders do arise in the course of the subcutaneous use of 
morphia they are prone to be very acute in character. A 
gentleman, aged about 32, came under my notice some 
months ago, suffering from dropsy of both legs, which, 
from the middle of the leg to and about the ankles, were 
covered with collections of minute red spots, evidently 
points at which the capillary blood vessels had ruptured. 
An examination of his urine discovered thirty per cent, 
of albumen and some tube casts from the kidneys. Also 
a decided amount of morphine, and considerable blood. 
He was put upon tonic remedies ; the legs, previously 
dressed with sulphate of iron ointment, were tightly ban- 
daged. After about two weeks the dropsy lessened, the 
spots disappeared and the general health improved suffici- 
ently to allow of a business trip to the West. No sooner 
had he neared his destination, however, than the dropsy 
of the legs again appeared, and the old trouble came back 
in full force. In addition, he became somewhat jaundiced, 
water made its appearance in the abdomen, and a most 
distressing nausea harassed him day and night. During 
all this time he managed to do an unusual amount of liter- 
ary work, that required both knowledge and tact. On his 



36 THE OPIUM HABIT. 

return to New York, he was in a very weak and debilitated 
condition. The stomach rebelled at almost every kind of 
food, the belly was distended with water, the nausea 
intense, the vomiting frequent, and urine high colored, 
bloody and containing about sixty per cent, of albumen. 
While in the West an attempt was made to gradually 
diminish the amount of morphia, but owing to severe ill- 
ness, was abandoned. Nor did I think it advisable to try 
again until the general health was better. Upon iron, in 
different forms (dialyzed, Bland's pills, and muriated 
tincture), strychnia, phosphorus and gentian, he gradually 
improved, and is now just commencing the treatment by 
gradual reduction. He consumes daily about ten grains, 
using it subcutaneously. He contracted the habit some 
five years ago, through its being administered to him 
hypodermically, during a severe attack of acute articular 
rheumatism. Two years ago he was broken of the habit 
by a physician in this city, who pursued the plan of sudden 
deprivation, with the result of nearly killing the patient. 

While traveling in Germany, for the purpose of reporting 
certain facts for his paper, he was suddenly taken with 
congestion of the brain, accompanied by intense pain and 
a state of semi-consciousness. A German physician who 
was called in, not knowing the man's previous history, 
gave him a subcutaneous injection of morphia, with the 
result of re-establishing the habit. 

Fluid in the abdomen is not a common complication, 
and when it does occur, crowds the stomach upward, in- 
terferes with the circulation of blood in the viscera in the 
abdominal cavity and renders the nausea and vomiting still 
more troublesome. 

The stools voided by morphia-maniacs are sometimes 
clay-colored, being devoid of biliary coloring-matter. The 



GENERAL SYMPTOMS ANALYZED. 37 

absence of bile in the intestinal canal allows of decompo- 
sition of the food, with the production of ill-smelling gases 
which regurgitate through the stomach, or pass by the 
bowels. Constipation is the rule. Sometimes it alternates 
with severe diarrhoea. In one patient whom I saw, the 
faeces collected day by day in the bowels, until impaction 
resulted and the mass was removed, with the greatest diffi- 
culty, by means of large enemata and the handle of a spoon. 
This lady had been using the drug, crude opium, for only 
eight months. 

This constipation from hardened condition of the faeces 
produces irritation, intestinal catarrh, and often hemorrhoids 
accompanied by an eczematous eruption about the anus. 

Heartburn, not from an excess of gastric juice, as is so 
often supposed, but from an acid fermentation of the food, 
is not an uncommon symptom. 

Some patients go on for years with no disturbance of the 
bowels, liver and stomach, beyond a slight catarrh and 
some jaundice, but these troubles are sure to come sooner 
or later. 

In many instances as the appetite for food decreases the 
appetite for alcoholic stimulants replaces it. A young lady, 
of twenty, formerly a patient of mine, after using the 
drug subcutaneously for three years, lost her appetite and 
subsisted for nearly eight months upon lager beer, a few 
crackers and a little toast. She would consume about one 
gallon of beer a day. During this time she somewhat 
diminished the amount of morphine used (eight grains, 
dropped to six grains, in twenty-four hours) and gained in 
weight and health. At the end of this time, however, 
severe gastric disturbance supervened, and she lay for 
months in a precarious condition. She is now cured of the 
habit. 



38 THE OPIUM HABIT. 

Alcoholic stimulants are used by some habitues to in- 
crease the effect of the morphia, which it does to a certain 
extent. They delude themselves into the belief that they 
will be enabled to thus reduce the amount of morphia 
used, but in the majority of cases this is a fallacy. Those 
who prefer laudanum and paregoric to opium or morphine 
often do so on account of the amount of alcohol contained 
in these preparations. I knew a gentleman, some years 
ago, now dead, an Episcopalian minister, who became 
addicted to the use of alcoholic stimulants. His excesses 
were so frequent and so degrading that it was found neces- 
sary to expel him from the church. Sobered by the blow, 
yet unwilling to entirely abandon his habit, he seized upon 
the expedient of using large quantities of laudanum, thus 
getting the effect of both opium and alcohol. He died 
some two years after, from taking an overdose, at the end 
of a spree, the first and last one in the two years. His 
tombstone is a monument to blasted hopes, unsat- 
isfied ambition, a life ill-spent, and ptfints a very pregnant 
moral to those who knew him. Let a man count well the 
cost before he takes service with a master who is only 
satisfied with a blasted life, here and hereafter. 

THE CUTANEOUS SURFACE. 

The effects of these drugs upon the skin may be divided 
into those relating to color, sensation and nutrition. The 
sallow, cadaveric hue so often seen in advanced cases is 
partly due to discoloration by the biliary matters, 
which are not properly excreted by the liver, and partly 
to a condition of malnutrition, so often seen in persons 
suffering from cancerous disease. In case there is serious 
interference with the working of the kidneys, the sallow 
color becomes less distinct, diluted expresses it well, and 



GENERAL SYMPTOMS ANALYZED. 39 

it has an appearance more like that of old white marble. 
In this case the tissue feels doughy and " soggy," and at 
points a pit made in the skin by the pressure of the finger 
remains. There is also puffmess under the eyelids and the 
eyes are bleared and watery. When there is no dropsy 
the skin is usually dry and harsh, although at times bathed 
with a cold, exhausting perspiration, the odor of which is 
oftentimes very offensive. A morphia or opium taker, 
previously ill-nourished, sometimes seems to improve, taking 
on flesh rapidly. The appearance, often best seen in the 
face, is very deceptive, and is, in the majority of instances, 
due to slight dropsy. It is sometimes seen a few weeks 
after these patients commence to use alcoholic stimulants, 
especially beer. It soon passes away, leaving them looking 
thinner and more miserable than before. 

In those cases where the habit has not progressed very 
far, the skin is usually made redder and coarser than 
natural, and is dotted here and there with pustules. 

In one case that I have recently had under my care, 
that of a young lady who had never used stimulants and 
who had only used morphia, and that subcutaneously, 
for seventeen months, a swollen and reddened condition of 
the nose, exactly like that seen in old drunkards, was pre- 
sent. Two weeks after the morphine was stopped the 
nose began to lessen in size and the color to disappear, and 
the condition was entirely cured at the end of three weeks. 
No local applications were used. 

Loss of elasticity of the skin is a common change. That 
nutrition is seriously interfered with is seen by this altera- 
tion, the loss of adipose tissue, the ill-balanced circulation, 
giving at one time coldness and paleness, at another flush- 
ing and undue warmth, and the variable secretion. A 
plump and well nourished person who commences the use 



40 THE OPIUM HABIT. ' 

of morphia loses those outlines of health caused by the 
proper development of the muscular system and normal 
distribution of fat beneath the skin. Face and form are 
both changed, and certainly for the worse. 

These changes are undoubtedly due to a double action 
of morphine ; that on the alimentary canal preventing the 
proper digestion and assimilation of food, and that upon 
the nerves regulating the supply of blood that passes to the 
skin. 

Eruptions after a time appear upon various parts of the 
body, more especially the face, chest and back. They are 
usually pustular, with hard, indurated bases ; sometimes 
papular. Herpes zoster or " shingles" is occasionally pro- 
duced, and is attended by most intolerable itching; less 
often purpura hemorrhagica. In the case of the literary 
gentleman already spoken of this was present, as was also 
bleeding from the kidneys. When it does occur the system 
must be in a greatly exhausted and the blood in a very 
poor condition, a condition which it usually takes a long 
time or large doses of the drug to produce. 

Another symptom dependent on disordered nutrition of 
the skin is the rapid or slow falling of the hair that occurs 
in some patients. However much hair restorers and scalp 
tonics may be used in these cases, the hair, once having 
commenced to fall, will continue to do so until the general 
health improves. When the drug has been stopped a free 
falling out of the hair occurs, followed by a new and 
luxuriant growth. Indeed, sweeping out and rebuilding 
seems to be the rule in every tissue. Change in color of 
the hair has been noted in some cases. 

Those affections of the skin due to the use of dirty solu- 
tions and unclean needles when the drug is given subcu- 
taneously will be spoken of fully presently. 



GENERAL SYMPTOMS ANALYZED. 41 

Sensation is variously altered. Sometimes there is a 
condition of hyperesthesia, the least touch being intensely 
painful, the contact of the clothing causing decided irrita- 
tion. Occasionally a whole limb or part of a limb or 
portions of the trunk or face will feel "numb or dead." 
Sometimes there are a series of pricking or tickling sensa- 
tions that are very aggravating, as they and the numbness 
are often looked upon by patients as precursors of paraly- 
sis. Sensitiveness to cold is often extreme. This and the 
very hard clay-colored stools are also seen in saccharine 
diabetes, and in every case where I have noted them 
sugar was found in greater or less quantity in the urine of 
the patient. What the connection is I cannot say, but it 
is worthy of further study. 

THE SEXUAL ORGANS. 

The continued use of opium or morphine has a decided 
effect upon the sexual apparatus. One of the first changes 
to be noticed in women is scantiness, then irregularity, 
and finally, total cessation of menstruation. In some 
cases an occasional period is observed, but as a rule, the 
stopping is decided and permanent until the habit is 
abandoned. Occasionally menstruation occurs when a 
change is made from one preparation to another, or from 
one mode of administering to another. 

In one of my patients, not under treatment for that, but 
still an habitue, menstruation showed itself, after a three 
years' cessation, on changing from the use of laudanum by 
the mouth to morphine by the skin. It occurred, however, 
but the once. 

In the case of the young married lady already referred 
to, when a change was made from subcutaneous to rectal 
injections the flow was re-established and showed itself, 
although irregularly, for nearly a year. 



42 THE OPIUM HABIT. 

Levenstein, who has made some interesting and valuable 
researches and experiments upon this matter, believes that 
this abnormal menopause is due to the inactivity of the 
ovaries. He says : — 

" According to Pflueger's theory, in cases of amenorrhcea 
due to morbid craving for morphia, the growth of the 
ovarian cells would be stopped from one monthly period 
to another, and consequently there would be a want of 
stimulus on the ovarian nerves, causing on the one hand 
the rupture of Graaf s follicles, and producing, on the other 
hand, a congested state of the generative organs by reflex 
action. Hence, the morphia would act in the same man- 
ner on the ovaries as on other secreting glands, i. e., 
would render them devoid of function under its continued 
influence. It is likely, therefore, that the menstrual dis- 
charge does not show on account of no ovulation taking 
place; this also would account for the sterility."* 

Accompanying this condition of non-menstruation there 
is always sterility. That this is due to the habitual use of 
morphia is proven by the fact that these women have borne 
a child or children before the use of the drug was com- 
menced, and have again become pregnant and gone to full 
term after the habit was abandoned. So long, however, 
as menstruation does occur, there is a possibility of the 
woman's becoming pregnant. 

In the majority of instances sensation is finally lost, 
although it is usually increased during the first few months' 
use of the drug. A patient of mine, a lady who had used 
morphine by the mouth for sixteen years, found her virile 
power during and at the end of that time in no way 
impaired. If anything, it was increased. Her dose of 
morphine was ten grains. She had not menstruated for a 

* Levenstein, op. cit., p. 69. 



GENERAL SYMPTOMS ANALYZED. 43 

longtime. This was the only case in which I tried Leven- 
stein's plan of at once stopping the drug, and I shall 
certainly never try it again. 

With the suppression of the menstruation, there some- 
times come the usual symptoms attending the suppression 
of this function in non-habitues. 

Levenstein states that ladies suffering from leucorrhcea 
are often cured of this complaint by the habitual use of 
morphia ; the discharge returning, however, as soon as the 
habit is broken, and causing labor-like pains. 

Certain it is that most female patients, on breaking the 
habit, surfer from a severe leucorrhcea, whether or not they 
had such a discharge previous to commencing the use of 
the drug. One of my lady patients who used six grains a 
day, subcutaneously, had a leucorrhceal discharge before 
she began the use of morphia, and upon which a four years' 
habituation had no curative or modifying effect. As soon, 
however, as the habit was broken, the discharge increased 
greatly in quantity, and changed in character, becoming 
more tenacious. 

Spasmodic closure of the mouth of the vagina on 
attempting to introduce the finger or a speculum, I have 
noticed in two cases. It, also, readily passes away after the 
use of morphia is abandoned. 

A woman becoming pregnant in the early course of her 
addiction to this habit will, in the majority of cases, abort 
before reaching full term, especially if the amount used is 
large. Levenstein has noted the fact that wives of men 
addicted to the habitual use of this drug in large doses 
had in the last two years never carried children to full 
term, although young, healthy, and having borne children 
before the husband became an habitue. 

There is no question in my mind but that the excessive 



44 THE OPIUM HABIT. 

use of this drug by one or both parents, but especially the 
mother, in case she is able to carry her child to full term, 
will modify disadvantageously the physical, mental, or 
moral development of the child thus born. A physician 
from the South tells me of the case of a lady who com- 
menced the use of opium at the beginning of her pregnancy. 
She was delivered of a fair-sized child that grew up in fair, 
though not robust health, and menstruated at the proper age. 
She is, however, very simple and childish, still plays with 
dolls, although a young lady, is very eccentric, and shuns 
the society of young men. The mother, who is still living, 
ceased to menstruate at the age of 30 and has never men- 
struated since, some twenty years. For the past two or three 
years she has been using sixty grains of gum opium daily. 

Dr. Alonzo Calkins* relates several cases where the chil- 
dren of such parents were either physically or intellectually 
deficient. I give but one of them: "At an inquest held 
by Dr. Macnish it appeared that a child five years of age, 
though to appearance only so many weeks old, had never 
been able to walk, nor so much as utter an articulate sound. 
The mother, during her gestation (as was in evidence), 
had taken to morphine, using a drachma day in the months 
just preceding her demise. A child born before the habit 
had become fixed showed a normal development and the 
aspect of general health. ' ' Another case is related where 
both parents were "healthy and robust by original consti- 
tution and by habits of life too, with the exception that the 
woman had, for a very considerable period, been in the 
practice of using morphine regularly and to great excess. 
An infant born subject to the liabilities, had only a very 
imperfect physical organization, with weak intellectual in- 
dications." 

By carefully conducted experiments on animals (preg- 

* "Opium and the Opium Habit." Philadelphia, 1871. p. 117. 



GENERAL SYMPTOMS ANALYZED. 45 

nant dogs and rabbits), Levenstein found that the continued 
use of morphia invariably produced abortion, the foetus 
being born dead. 

With the cessation of the menses the breasts usually 
dwindle in size, and the voice attains a more masculine 
tone. 

In man the first indication of an effect on the sexual 
organs is increased desire ; this, however, giving way 
sooner or later to partial or total impotence. The fact, 
noted by Levenstein, regarding the rarity of conception 
and parturition in the wives of habitues, has already been 
spoken of. If the amount of opium or morphine used is 
small, impotence may not come for a number of years. 
The power of partial or full erection, without emission, is 
preserved by some. In those cases where there is inability 
to impregnate the female, there undoubtedly exists a 
deterioration of the functional power of the testes. In one 
case which I saw the testicles were markedly atrophied. 
In two cases I was fortunate to be able to examine the 
seminal fluid, a few days after the habit had been broken. 
These patients, as is usual on recovery, were troubled with 
erections and nocturnal emissions. In both instances the 
zoosperms were small, and present in less than the normal 
quantity. In one case, where it was possible, owing to 
the patient's having been previously instructed, I was able 
to examine this fluid once or twice weekly for nearly two 
months. Each succeeding examination showed a larger 
number of zoosperms, each sample apparently better 
developed than the preceding. 

Even large doses sometimes fail to produce impotence. 
One young man, twenty-five years of age, who has been 
taking, subcutaneously, ten grains of morphia, for over 
three years, is a confirmed masturbator, and seems to have 
frequent emissions. 



46 THE OPIUM HABIT. 

CHAPTER IV. 

GENERAL SYMPTOMS CLASSIFIED AND ANALYZED. 
THE URINARY ORGANS. 

Albuminuria, usually temporary, is not an uncommon 
result of the prolonged use of morphia. The deposit, after 
applying heat and nitric acid, may vary from one-twentieth 
to one-seventieth per cent, of bulk. In some cases it comes 
and goes, one day appearing as a slight, hazy cloud, and on 
another as a measurable deposit. Albuminuria and diabetes 
are more commonly found in patients who use trie drug 
hypodermically. In some rare instances casts, epithelial, 
granular, hyaline and bloody, are to be found in the urine, 
as also free renal cells, apparently healthy. This was the 
case with the literary gentlemen spoken of in the second 
chapter. This does not indicate organic disease of the 
kidney, for after the withdrawal of the drug the albumen 
and casts gradually disappear. 

The specific gravity of the urine varies according to the 
bodily condition of the patient, the weather and the 
amount of fluid ingesta used. If sugar is present the 
gravity is high ; if albumen, usually low. In nervous and 
hysterical women there is a low gravity with an excess of 
the alkaline phosphates. In nearly all cases the uric acid 
is increased after the drug has been used for a time, the 
urea is very materially diminished, due probably to the 
small amount of food taken, the congested and deranged 
condition of the liver, and the impeded tissue metamor- 
phosis. The chlorides are always slightly, sometimes 
markedly, diminished in amount. 



GENERAL SYMPTOMS ANALYZED. 47 

Levenstein concludes, from his observations on patients 
and experiments on animals, in whom the continued use 
of morphia produced albuminuria, that this affection is due 
to varying blood pressure in the renal vessels through the 
nerves supplying them. 

Contrary to the experience of Levenstein, I have found 
sugar in the urine of some (four) of my patients. This, 
like the albuminuria, was permanent in one case, and came 
and went in the other three. Its presence was undoubted, 
it reducing the copper of Fehling's liquor (previously 
tested) and answering to the fermentation and bismuth 
tests. In three of the cases it disappeared after stopping 
the morphia. The fourth patient is still under treatment. 

Levenstein finds that acute poisoning by morphia, in 
men and animals, is always accompanied by sugar in the 
urine. 

Strangury and retention of urine is occasionally the result 
of the long continued use of the drug. 

The albuminuria of morphia-mania is sometimes accom- 
panied by dropsy of the feet and limbs, less often of the 
abdomen and pleural sacs. When thus occurring the case 
is a grave one, and it will take time to decide whether 
there is not real organic disease of the kidneys, in which 
case the breaking of the habit may cause death by convul- 
sions. 

THE EYES. 

It is a rare thing to find actual disease of the eyes that 
can be traced directly to the abuse of morphia. It is usual 
to find the retina somewhat congested. Blurring of sight 
and double vision are sometimes complained of. Muscse 
volantes, or specks floating before the eyes, are sometimes 
seen. One patient of mine who had been near-sighted 
four years, during which time she had used the drug sub- 



48 . THE OPIUM HABIT. 

cutaneously, claims to have regained full power of sight 
since the habit has been broken. 

The pupils are, as a rule, contracted and regular, occa- 
sionally of normal size and irregular. 

THE MUSCULAR SYSTEM. 

Locomotion is rarely affected during the continuance of 
the habit, save from weakness. Twitching of isolated 
muscles, such as the orbicularis palpebrarum of one eye, 
is sometimes seen. When the doses of opium or morphine 
become very large, co-ordination is sometimes interfered 
with. Wasting of the muscles is found in advanced cases, 
as also is trembling of the hands. 

RESPIRATION. 

Respiration is rarely affected. In some cases there is 
shortness of breath on walking fast or going up. a long 
flight of stairs. A low grade bronchitis sometimes exists, 
as also a short, hacking cough, that seems to come chiefly 
from irritation in the throat. 

THE CIRCULATION. 

Circulation is often affected but chiefly through the 
agency of the nervous system ; witness the flushing of the 
face, and flashes of heat over the body, followed by a cold, 
exhausting sweat. There is often irregular and weakened 
action of the heart, and congestion of the brain. The 
albuminuria already spoken of is due, in all likelihood, to 
an affection of the vessels of the kidneys, through the 
nerves supplying them. The blood itself, owing to a gen- 
eral condition of malnutrition and imperfect digestion, is 
unquestionably deteriorated. In some cases the vessels 
rupture, giving us purpuric spots on the body and hemor- 
rhage from the kidneys and bowels. Dropsy, which some- 



GENERAL SYMPTOMS ANALYZED. 40 

times occurs, is due, in the majority of instances, to variable 
blood pressure, and a diseased condition of the walls of the 
vessels, permitting the easy transudition of the watery ele- 
ment of the blood. Headache, flushing of the face, flashes 
of heat and the Tike, from suppression of the menses, is seen 
during the early period of morphia addiction, but later 
nothing but the nervous symptoms attendant upon this 
condition are manifested. 

THE MIND. 

Early in the use of morphia the effects upon the mind 
are simply those of pleasant exhilaration, a feeling of per- 
fect contentment, good will toward all, increased conver- 
sational power and stimulation of the imaginative faculties. 
Sleep is preceded by a period of luxurious drowsiness, 
fertile in pleasant retrospective and magnificent anticipa- 
tion. There is total banishment of pain and care. It is, 
indeed, the ideal life of a dreamer, moulded and modified 
according to the temperament and intellectual tendencies 
of the individual. 

As time advances, however, the duration of these periods^ 
is found to become shorter, and it is necessary, in order 
to obtain the same pleasant result, to increase the amount 
of the drug. It has, also, to be taken oftener. Sleep, 
when it comes, is less profound, the dreams not so pleasant. 
Should the patient pass the accustomed time for the drug, 
the loss is at once felt and the first symptoms of rebellion 
show themselves. A further and larger dose is taken,(to 
quiet the rebellious demon that rules them, and again 
comes the pleasure, though not so satisfying as at first. 
The hours of freedom from the tyrant become shorter and 
shorter, sleep refuses to come, grave doubts fill the mind, 
the temper is no longer even and pleasant, but irritable 



50 THE OPIUM HABIT. 

and capricious, pains show themselves in various parts of 
the body, the nights are long hours of torment, conversa- 
tion becomes a burden, suspicion shows itself, a desire to 
be alone is overpowering, better feelings are blunted, be- 
nevolence is replaced by selfishness, mental stimulation 
and exhilarance by torpor. Friends are neglected, the 
books that were once interesting are no longer so, amuse- 
ments pall upon the taste, family ties, once so pleasant, 
are become burdensome, and life a dreary space, marked 
only by the hour at which the drug is to be taken. The 
days are filled with repentance, the hours garnished 
with resolves no sooner made than broken, 

"O woeful impotence of weak resolve," 

the nights years of misery and anguish, teeming with 
horrors beyond the power of tongue or pen to paint. 
Here is the plaint of one, now freed from his bond- 
age : * "The morphia victim dwells, after the first 
exhilaration is gone, in a realm of phantoms and 
shadows. I saw sights more terrible than can be imagined. 
I felt pains that do not belong to any mortal lesion. I 
have shrieked my terror, but the shriek only awoke a 
myriad of devils, who had been sleeping till then unseen 
by me. Four months of morphia addiction sufficed to 
bring me to this land of horrors, where no joy came or has 
come since the making of the world. My days were spent 
in self-indulgences. Alone in my office, in an easy chair, 
I could, with poetry and interesting therapeutical works, 
manage quite comfortably to pass the hours away. But let 
a patient summon me away from home, and my gloom and 
despondency was almost insupportable. I was tormented 
by continual self-conflict. Conscious of the weakness of 
my efforts to emancipate myself, I kept on planning some 

* The Personal Experiences of an Ex-opium Habitue. — N. Y. Medical Record, 
p. 399, Vol. xiii. „ 



GENERAL SYMPTOMS ANALYZED. 51 

new mode of attack, in the nerveless hope that I could de- 
the Lethean devil whose thews were strong as steel, 
and yet I knew, as day followed day, and week followed 
week, in so far as all this mental warfare was concerned, it 
could bring me no help in my awful bondage. 

" No dark imagery can paint the encompassing horrors 
of those nights of torment that belonged to the last two 
months of my twelve months' morphia addiction. Not one 
hour that I passed in bed between midnight and noon did 
I know normal sleep. In dreams that seemed more vivid 
than reality, I entered gloomy caves, and walked for hours 
over rotten cadavers, sometimes forced to step on them 
and be overwhelmed with loathsome odors. I saw faces 
in the weird darkness, sometimes a thousand at once, and 
each was made of blood-red flame \ they flashed and went 
out. My nightmared brain was chased and haunted by 
everything that can exist in a vast hell of phantoms." 

Apropos, the following from Moore's "Veiled Prophet 
of Khorassan " : — 

" Dreadful it was to see the ghastly stare, 
The stony look of horror and despair, 
Which some of these expiring victims cast 
Upon that mocking Fiend ? whose veil, now raised, 
Showed them, as in death's agony they gazed, 
Not the long- promised light, the brow whose beaming 
Was to come forth, all conquering, all redeeming, 
But features horribler than Hell e'er traced 
On its own brood ; no Demon of the Waste, 
Xo church-yard Ghole, caught lingering in the light 
Of the blessed sun, e'er blasted human sight 
With lineaments so foul, so fierce as those 
The Impostor now, in grinning mockery, shows : 
1 There, ye wise Saints, behold your Light, your Star, 
Ye would be dupes and victims, and ye are. 
Is it enough ? Or must I, while a thrill 
Lives in your sapient bosoms, cheat you still ? ' " 




52 THE OPIUM HABIT. 

Thus it is, pursued to the very grave-edge, these victims 
loathe the drug they once loved. Business is gone, family 
broken, friends lost, moral sense blunted or destroyed, 
mind incapable of healthy action, body wrecked, and they 
see no hope here or hereafter. 

They will lie and steal, do almost anything to obtain the 
drug with which and without which they are finally in a 
veritable hell. The face becomes sallow and soggy, the 
eyes bleared and expressionless, and the final result is 
either death or insanity. Some persons go on using these 
drugs for years before the symptoms here described super- 
vene ; some are thus affected in a few months. 

Having reached this stage they cannot arouse themselves 
from their terrible infatuation. Gloomy and hopeless, the 
world and the people in it no longer interest them. A 
patient whom I saw some years ago, a young Spaniard, was 
suffering from insanity from the use of morphine. Hour 
by hour he would sit folding, refolding and cutting paper 
into small bits with an old lancet. He would speak to no 
one, notice no one. This went on for months. He was 
sent to an insane asylum finally, and on searching his 
trunk some two score morphine bottles, as well as the 
greater part of the trunk, was filled with these minute 
scraps of paper. I have never been able to learn what 
became of him. 

A lady patient of mine, well advanced in years, would 
save scraps of tin, old bits of rags, glass stoppers of bottles, 
and the like, setting great store by them. She laughed 
heartily at her collection, and threw them away one week 
after her emancipation. 

Sometimes there is a mawkish sentimentality exhibited 
toward the opposite sex ; sometimes there is mock 
modesty or direct abhorrence. 



GENERAL SYMPTOMS ANALYZED. 06 

In the majority of instances these people are great liars, 
especially about matters concerning their habituation ; 
often also about trivial things, where falsification is absurd 
and absolutely without excuse. 

Occasionally there is a loss of connection between ideas 
in talking, incoherence and silliness. The speech is, as a 
rule, slow and somewhat drawling, and often interrupted 
to wet the lips, which become dry and parched. Severe 
pain in the head and about the region of the heart is some- 
times complained of, also in the " small of the back." 

In some cases, more especially those of an intensely ner- 
vous organization, the prolonged abuse of opium or mor- 
phine produces a condition characterized by cerebral ex- 
citement, analogous to that of delirium potatorum. These 
people are, however, less violent, and the affection usually 
passes away in a short time, without treatment. 

THE NERVOUS SYSTEM. 

On the nervous system the effects of opium and morphine 
are most manifest. Taken at first to relieve pain and dis- 
orders of this system, having their chief action upon it at 
all times, their continued use reacts with deadly intensity. 
Twitching of isolated muscles, trembling of the hands and 
of the tongue, when protruded, and occasionally paralysis 
of one eyelid, are seen. The pains that supervene have no 
distinctive character, as do those that come from the abuse 
of chloral. 

Itching of the whole or parts of the body is sometimes 
very troublesome. Herpes zoster (shingles), an eruption 
following the distribution of the nerve filaments upon the 
trunk, occasionally occurs, as also does urticaria (nettle 
rash). The very disorder for which the drug was first 
taken, is, in some instances, aggravated or perpetuated. 



54 THE OPIUM HABIT. 

This was first noticed by -Dr. T. Clifford Allbtitt* of 

England, and I have seen the same in some instances. 

In the condition of delirium sometimes occurring, the 
pupils, usually contracted, are occasionally irregular and 
dilated. 

The whole nervous system is unstrung, or more properly, 
too highly strung, so that it vibrates to little things that in 
health would pass unnoticed. They jump at the falling of 
a book or the shutting of a door. 

Hysterical women still continue to have their customary 
attacks, sometimes in an aggravated form. 

The following interesting case history has been kindly 
sent me by Dr. Judson B. Andrews: — 

A woman,")" thirty years of age, single, seamstress, with 
no hereditary tendency to insanity; was of a highly 
nervous and excitable organization, emotional and irregu- 
lar in feeling ; at times buoyant and lively, and then 
gloomy and depressed. Her health during early life was 
delicate, though she suffered from no definite form of dis- 
ease. At the age of twenty, in April, 1862, she was seized 
with pain in the head. It was of short duration, but very 
severe, and during its continuance the patient was deliri- 
ous. Attacks of the same character, both in the severity 
of the pain and the mental disturbance, have occurred 
since, at intervals of from one to three months, j In 1864 
she had acute rheumatism, and in 1865 a severe attack of 
diphtheria. 

After the local disease of the throat had apparently sub- 
sided vomiting supervened, and was repeated every few 
hours for some five weeks. To relieve this condition and 

* Practitioner, 1871. 

f American yournal of Insanity , July, 1872. 

% From the subsequent history of the patient, especially while in the asylum, we are 
led to believe that these attacks of delirium took place at menstrual periods. 



GENERAL SYMPTOMS ANALYZED. 55 

procure sleep, hypodermic injections of morphia were suc- 
cessfully employed for about one week, and the patient 
rapidly regained her health. Some two years after this, or 
in July, 1867, she had an attack of inflammation of the 
bowels and peritoneum, and for four weeks was delirious 
most of the time. She improved somewhat in health, but 
for the four months succeeding had frequent attacks of 
frenzy, during which she often threatened to take her own 
and her mother's life, and became very difficult to control. 
In October following she had improved so far as to pass 
from the immediate charge of her physician. Soon after 
this he ascertained she was using hypodermic injections of 
morphia, to relieve pain in her limbs and different parts of 
her body. I quote from his letter: — 

I was informed that she was using it (morphia) to a consider- 
able extent, and called immediately to explain to her the effects 
and danger attending the practice. I believe every effort was 
made that could be to prevail upon her to desist, but all to no 
purpose. She was cunning and artful, and would almost al- 
ways study out some plan to get the morphia. She has used 
as much as two drachms in a week, in one or two well-authen- 
ticated instances. The usual amount was one drachm per 
week. She used but little, if any, for three or four months 
before she was sent to the asylum, for it was very difficult for 
her to get it. She has acted very strangely ever since her first 
sickness. She has been truly a mystery, which no one could 
solve. 

Her mother says : — 

That for years she has complained of pain, and pressed her 
hand on either side of her head, with the exclamation, "Oh, 
mother, mother, I shall die ! " That for six years she has com- 
plained of such soreness of the head that when she passed her 
hand over it, in smoothing her daughter's hair, she would cry 
out: "Oh, mother, don't ; it hurts me so!" That five years 



56 THE OPIUM HABIT. 

ago, in 1867, she was obliged to call in help, as the patient 
threatened and intended to take her own life. That both be- 
fore and after she began the use of morphia, her conduct was 
peculiar and erratic ; that she was emotional and easily dis- 
turbed by trifles. That after the morphia habit was known, 
her conduct for many years preceding was wrongly attributed 
to this cause. 

A few weeks before she was sent to the asylum she 
passed into an acutely maniacal condition, in which she 
was sleepless, ate little and irregularly, lost flesh and 
strength rapidly, and became quite feeble. She was de- 
structive of clothing, pulled her hair out, was noisy, inco- 
herent and violent ; opposed care, wandered about, and 
was with difficulty controlled. In this condition she was 
admitted to the institution, on the fifth of May, 1871. 
She was carried to the ward and placed in bed. Examina- 
tion revealed scars and ecchymosed spots, covering nearly 
the whole of the body which could be reached by her own 
hand. She asserted that she had employed the hypodermic 
injections for three and one-half years, once, and much of 
the time twice, a day, making in all about two thousand 
injections \ that during the last few months of its continu- 
ance she had used a drachm and one-half of morphia per 
week 1 that she inserted the needle perpendicularly to the 
surface, and often carried its full length into the tissues. 
For two days she was sleepless and retained no nourish- 
ment. Chloral, in thirty-grain doses, was then admin- 
istered, which was tolerated by the stomach, and secured 
sleep. The vomiting gradually became less frequent and 
soon ceased. She ate well, gained flesh and strength, all 
maniacal symptoms subsided, and in twenty days she was 
up and about the ward. Menstruation, as she said, had 
been suppressed for two years. As she complained of pain 



GENERAL SYMPTOMS ANALYZED. 57 

in the back and other symptoms which usually preceded it, 
she was placed on the use of capsules of apiol, and on the 
24th of June began to menstruate, but the flow was scanty, 
and accompanied by much pain. 

During the month following she steadily gained in men- 
tal strength, and became quite stout. At time of next 
menstrual period the right breast swelled to an extraordi- 
nary size, so that we were obliged to suspend it with adhesive 
straps. It was hard and extremely sensitive to the touch. 
This condition of swelling and tenderness extended in a 
narrow ridge to the spine. The state of the breast was at 
first supposed to be owing to the sympathetic action of the 
organ with the renewed activity of the menstrual function. 
For two weeks applications were employed, without suc- 
cess, to relieve the pain and tension. At this time, on the 
13th of August, the patient, in rubbing her hand over the 
breast, discovered an elevated point just under the skin, 
which, on pressure, gave a pricking sensation. This was 
cut down upon, and a broken needle extracted. On the 
15th another needle was removed. The breast was now 
inflamed and extremely sensitive. August 28th, another 
needle was taken out. August 29th, menstruation began 
again. The flow was profuse, and she became at once 
delirious. Was talkative, restless, profane and obscene, 
and pulled her hair out. She continued in this condition 
some twelve hours, and, as she stated the next day, was 
entirely unconscious of what had occurred. 

From this time till September 28th, from one to five 
needles were removed daily from the breast. Menstrua- 
tion then occurred again, and was characterized as before 
by a similar attack of mental disturbance. After this, 
during the months of October and November, needles 
were taken from various parts of the body ; from the left 



58 THE OPIUM HABIT. 

breast, the abdominal parietes, the mons veneris, the labia, 
and vagina. Of these latter, some passed across the 
urethra and rendered urination difficult and painful ; 
others across the vagina, either end being imbedded in 
opposite sides. Some were removed from the thighs, from 
the leg, down to the ankle, from the buttocks, from about 
the anus, from the back as high up as between the shoul- 
ders. The largest number extracted in any one day was 
twelve. 

On one occasion ether was administered, but the diffi- 
culty experienced in bringing her under its influence, and 
the mental disturbance produced by it were so great that 
it was not again resorted to. During the whole period, to 
her final illness, she retained her flesh, though she ate and 
slept irregularly, under use of tonics and sedatives. She 
was in a variable mental state, at times irritable, petulant, 
fault-finding, attempting to create ill-feeling between 
attendants, and demanding unnecessary care and waiting 
upon. At other times she was abnormally cheerful, gay, 
pleasant, and fulsome of praise of all around her. 

For the first two months but comparatively little pain 
was felt in the extraction of the needles. The skin was 
thickened, harsh and dry, and almost insensible, from the 
prolonged and distributed use of the injections. After- 
ward, she suffered acutely, and often begged, with tears, 
that their removal might be postponed from day to day. 
About a month before death she had an attack of localized 
pneumonia, affecting the lower portion of right lung. 
This was accompanied by stridulous breathing, spasm of 
the glottis, globus hystericus, crying, and other hysterical 
manifestations. It was followed by an attack resembling 
muscular rheumatism, characterized by great pain and 
hyperaesthesia of surface. The right arm was swelled, hot 



GENERAL SYMPTOMS ANALYZED. 59 

and extremely sensitive. It was supported on a pillow and 
kept bathed in anodyne lotions. She lost appetite and 
sleep, became much depressed, and gave up all hope of 
recovery. Her tongue became dry and brown, pulse rapid, 
secretions offensive, and mind very feeble. A diarrhoea 
supervened and the evacuations of bowels and bladder were 
involuntary. She became unconscious, and finally coma- 
tose, and died on the 25th of December, 1871. 

No needles were removed during the last two weeks ; 
286 were taken from her body during life; n were found 
in the tissues after death ; 3 were passed from the rectum 
during sickness ; making a total of 300 needles and pieces. 
Of this number, 246 were whole, and 54 were parts of 
needles. One was a No. 7 sewing machine needle, and 
several were bent. They varied in size from No. 4 to No. 
12. As regards position in the body, they were distributed 
about as follows : in right breast 150 ; left breast, 20 ; ab- 
domen, 60 ; genitals, 20 ; thighs and legs, 30 ; back, 20. 
Of those removed after death, 5 were found in the right 
and 3 in the left breast ; one in a small abscess in the epi- 
gastric, and one in the right iliac region, the point im- 
pigning upon the peritoneum, which was discolored with 
rust ; and one in the upper part of lower lobe of left lung. 
The presence and position of the needles were indicated to 
the patient by the pricking sensation occasioned by mus- 
cular movements. They were removed in a few instances 
at first, by cutting down upon them. This proved to be a 
painful, and, from the movements of the needles in the 
tissues, a difficult process. Hemorrhage from the small 
vessels, at times, gave some trouble. Afterwards, by 
manipulation, the ends of the needles were engaged be- 
tween the thumb and forefinger, and the points, forced 
through the skin, were seized and the needles extracted 



60 THE OPIUM HABIT. 

with forceps. Sometimes much force was required to 
withdraw them. They changed position quite readily, and 
frequently moved from one to two inches in a day. They 
produced little local irritation or trouble beyond the 
pricking sensation, and did not seem to have contributed 
in any notable degree toward producing the fatal result. 
In regard to the presence of this large number of needles 
in the system, no information could be obtained. The pa- 
tient repeatedly and persistently denied any knowledge of 
having introduced them, either by the stomach or through 
the skin. Her mother, who visited the Asylum, could 
throw no light upon the subject, and was entirely ignorant 
of the fact until informed by us. She, however, recalled 
the circumstance that the patient purchased, at one time, 
ten papers of needles, and could account for only two of 
them. They were not obtained or introduced while in 
the Asylum. She was under strict surveillance, and had 
no means of obtaining any number of needles, and those 
removed were all rusted and bore evidence of having been 
a long time in the body. The stomach was closely exam- 
ined after death, and was in a perfectly healthy condition, 
with no evidence of any previous inflammatory action. 

The only theory which seems to us at all tenable, is 
that they were introduced through the skin while she was 
under the influence of morphia, hypodermically admin- 
istered, and while suffering from hysteria. That some were 
found in positions where they could not have been inserted 
by the patient, can be accounted for by their movements 
in the tissues, which were observed so often during the life 
of the patient. 

The diseased condition of the brain and its membranes 
was a cause sufficient to account for the abnormal mental 
action and conduct of her who had been ' ' truly a mystery 



GENERAL SYMPTOMS ANALYZED. 61 

which no one could solve." We close this remarkable 
rase with a transcript of the post-mortem examination. 

Autopsy. — Rigor present ; body well nourished ; anterior 
surface thickly studded with small cicatrices; abdomen 
covered with thick layer of fat. A small abscess in abdom- 
inal wall, two inches above umbilicus, three inches by one 
and one-half, was filled with pus and contained one needle. 
A second abscess, two inches above and to the right of the 
symphysis pubis, immediately under Poupart's ligament, 
contained another needle. This pressed upon the perito- 
neum, which, though discolored by rust, was not inflamed. 
From the right breast, one whole and four broken needles, 
and from the left one whole and two broken needles, were 
removed. 

Head. — Arachnoid opaque and thickened over right 
hemisphere. The left hemisphere was covered by a thin 
layer of pus, contained in the sub-arachnoid space. Marked 
depression of convolutions at vertex of both hemispheres. 
The brain substance was firmer than normal. The ven- 
tricles were empty, and the choroid plexus contained numer- 
ous small cysts upon its surface, filled with serum. 

Thorax. — The lower lobe of the right lung was hepat- 
ized. A whole needle was found in the upper part of the 
lower lobe of the left lung. 

Abdomen. — The liver was soft and fatty, and the spleen 
enlarged ; kidneys were normal. The stomach was sub- 
jected to a critical examination. It was found normal, and 
there was no evidence that the needles were introduced 
into the system through that organ. 

The vascular system, through the agency of the nerves, 
is profoundly affected, as already shown. 

Spasm of the muscles of the bladder and rectum is some- 



62 THE OPIUM HABIT. 

times present, and in some cases is distressing and lasts for 
a considerable time. 

Symptoms resembling those produced by malaria are 
occasionally found. Levenstein, who was the first to call 
attention to this, says : "Intermittent fever, in consequence 
of a morbid craving for morphia, seems to be due to a cer- 
tain neuropathic disposition, as it does not show itself with 
many patients, although they have taken large doses of the 
drug, and for years together. It was, however, impossible 
to fix on any other cause for the development of intermit- 
tent fever but the use of morphia, as the respective 
patients lived in regions free from malaria, and as none of 
the other members of the family living under the same con- 
ditions showed any similar symptoms. 

" We may distinguish a light and a severe type of inter- 
mittent fever, when brought on by a morbid craving for 
morphia. Both forms resemble real malarial fever, inas- 
much as the first paroxysms, occurring at regular intervals, 
seemed to disappear after the use of quinine, returning, 
however, very soon, although the febrifuge was continually 
given ; that, furthermore, they were improved by change 
of air, but came on again from the simplest causes, such as 
boating, errors of diet, etc. 

"The characteristic symptoms of this fever are the same 
as those caused by malaria: chilly feeling,' up to regular 
shivering, headache, oppression, heat and perspiration. 
They differ from one another in this respect, that immedi- 
ately the morphia is discontinued, the attacks disappear 
without any treatment, although they may have existed a 
long time. 

' i In some cases the intermittent fever sets in in an erratic 
manner. The patient, at irregular times, experiences an 
attack of fever, with chill, heat and sweating. These 



GENERAL SYMPTOMS ANALYZED. Go 

attacks occur from three to six times, at long intervals, not 
showing themselves hereafter any more at all, or only after 
a great lapse of time. In most cases the attacks of inter- 
mittent fever, in morbid craving for morphia, shows a 
tertian, rarely a quotidian, type. They are sometimes 
ante-, sometimes post-ponent. The attacks last from four 
to ten hours, and are followed by a normal condition. 

"The paroxysms disappear only in exceptional cases, 
without the morphia being stopped. In this case the 
patients complain of experiencing an uncomfortable sen- 
sation, principally of an exhausting character, at the usual 
time of the attacks. 

"The feverish attacks are accompanied by neuralgic 
affections of the different nerves, principally in the region 
of the supra-orbital, intercostal and cardiac nerves. The 
temperature is increased in all cases, varying from 38. 5 ° 
C. to 40 C. (101.3 F. to 104 F.). The spleen is gener- 
ally enlarged. The attack is followed by sediments in the 
urine. In the severest forms of intermittents the patients 
get delirious when the fever has reached its maximum, 
cannot be kept in bed and may become maniacal. Both 
forms cause great weakness and exhaustion, which last 
during the intervals." 

I have seen but two cases that could at all be classed as 
such. In one there was no fever, and the chill came every 
morning at daybreak, for three mornings, missed one morn- 
ing and occurred again the next. It was followed by pro- 
fuse sweating, that lasted the whole day. In the other 
case, that of the lady who had used the drug by the mouth 
for sixteen years, there w r as fever and some intercostal 
neuralgia, occurring every other day, for ten days, but not 
followed by perspiration. A. few doses of quinine broke 
it up. It was for this that I was first called to attend her, 



f>4 THE OPIUM HABIT. 

her husband believing her to be suffering from malarial 
fever. In neither of these cases was there any enlargement 
of the spleen. I then discovered that she was a morphine 
habitue, much to her chagrin and her husband's surprise, 
he never having suspected it. The two following cases 
are those given as examples by Levenstein : — 

CASE I. INTERMITTENT FEVER IN CONSEQUENCE OF MORBID 

CRAVING FOR MORPHIA. 

M. H., law student, 24 years old, sent to the Institution 
by Dr. Ewald in 1874, was suffering from acute articular 
rheumatism when the first injection of morphia was admin- 
istered. After his recovery, although not compelled to do 
so through pain, he continued the injections several times 
in the day, increasing the doses, for the sole reason that he 
felt elated by them. The principal symptoms that resulted 
therefrom were loss of appetite, progressive emaciation, 
loss of strength, and increased perspiration, which fre- 
quently caused the patient to become wet all over while in 
a cold room and quite quiet. 

Before his admission into the Maison de Sante he was 
troubled with feverish attacks, which came on every two 
or four days, at different times in the day, in the following 
manner : first there was a chilly feeling for half an hour, 
followed by heat and profuse sweating. The latter was 
accompanied by the general symptoms of every feverish 
attack, enlargement of the spleen also being present. 

Present State. — Patient is a tall, muscular man ; the ex- 
amination of the internal organs shows no abnormal con- 
dition, excepting an enlarged spleen. Pupils of middle 
size, equal, reacting well. On December 10, 1875, m 
the afternoon, patient received the last injection of 
morphia. 



GENERAL SYMPTOMS ANALYZED. 65 

December 12. Patient slept in the night. In the course 
of the day he only feels a little sleepy. The face is red, 
the skin moist. Toward the evening there is nausea, 
pressure in the epigastrium, great restlessness, and stomach- 
ache. Patient moves about in bed, complains of headache, 
cannot get to sleep. Three relaxed motions. 

December 22. Patient has had no sleep during the 
night, three relaxed motions, vomited once. He com- 
plains of giddiness, restlessness and palpitation of the 
heart. In the morning there is a chill followed by heat 
and profuse sweating. Vomiting, diarrhoea. Until the 
afternoon he felt very prostrate and exhausted. Between 
3 and 5 p.m. he got up. Soon, however, the symptoms of 
the morning returned again, and pain in the knees, exhaus- 
tion and restlessness compel him to go to bed. 

December 23. Has slept from 2 to 5 a.m. with inter- 
ruptions. Profuse perspiration, nausea, intense craving for 
morphia, frequent paroxysms of sneezing. The sickness 
stopped in the course of the day. At 8 p.m. 30 grains of 
chloral were given. 

December 24. Only three hours' rest. Feels knocked 
up. One relaxed motion. Much sneezing; craving for 
morphia. At 9 p.m. 45 grains of chloral were given, but 
were immediately brought up again. 

December 25. Patient has had hardly any rest. One 
relaxed motion. Has been sneezing frequently. Emission 
of semen. Great prostration, even in the horizontal 
posture ; red cheeks ; craving for morphia continues for 
the whole of the day. Appetite small. At 10 p.m. 45 
grains of chloral. 

December 26. He has slept well during the night, only 
woke up two or three times. Pressure in the stomach, 
headache and palpitation of the heart come on now and 



66 THE OPIUM HABIT. 

then in the course of the day. At n p.m. 40 grains of 
chloral were given. 

December 27. Restless sleep, much interrupted. Pa- 
tient went about the room cm waking up. During the 
day he complained of heavy pressure in the head. 

December 28. Patient has slept for about three hours. 
Sneezing. The red color of the face of the past days was 
still present to-day. Although tired he could get no rest. 
Two relaxed motions. In the morning a warm bath with 
cold douche was given. 

December 29. Patient has slept for nearly eight hours. 
Head not well yet. Severe sneezing. He feels better in 
himself. Toward the evening, however, an uneasy feeling 
came on in the legs. Three relaxed motions. 

January 1, 1876. Except the sleep being restless, 
patient feels well. 

January 3. Slept only from 3 a.m. ; ran about in a rest- 
less manner previously. Three relaxed motions. In the 
afternoon warm bath with cold douche. 

January 13. The bodily functions are all in a normal 
condition. General health good. There have been no 
further attacks of fever. 

January 14. Patient left the Institution. 

He has had no relapse. 

Urine. — The specific gravity varied from 1.012 to 1.020. 
Reduction of oxide of copper was noticed. 

CASE II INTERMITTENT FEVER IN CONSEQUENCE OF MOR- 
BID CRAVING FOR MORPHIA. (IMPOTENCE. DISORDERED 
SPEECH. ALBUMINURIA.) 

Captain B., sent to the Institution by Staff-Surgeon Dr. 
Peltzer, had been using injections of morphia in conse- 
quence of severe pains from a gunshot wound in 1871. 



GENERAL SYMPTOMS ANALYZED. 67 

For a time his medical attendant diminished the drug, but 
soon, by the advice of the latter, he purchased a syringe 
and bought the morphia, first at a chemist's, and afterward 
at a shop where they sold chemicals ; he injected gradually 
as much as twenty-four grains per day. Several times his 
wife tried to stop the injections or at least to diminish the 
dose, but this was followed by vomiting, diarrhoea and loss 
of sleep, so that the doctor again recommended its further 
use. 

The principal complaints of the patient, on account of 
which he, on December 20, 1875, sought admission into 
the ' Maison de Sante,' were: The appetite is bad, the 
bowels are so much constipated that they are sometimes 
not relieved for eight days. From time to time patient 
suffers from disordered micturition, having to strain rather 
long before the water passes. Very frequently there was 
congestion to the head, and during sleep quivering of the 
muscles of the face and extremities. Now and then he 
suffered from giddiness and headache. He feels unwell, 
principally in the morning. Impotent for three years. 
He was obliged to resort to alcoholic beverages as stimu- 
lants, but he was no drunkard. From September 12 until 
the end of October, 1874, the patient had had a shivering 
lasting two hours daily, followed by half an hour's heat 
and two or three hours' profuse perspiration. Large doses 
of quinine taken daily for a period of three weeks are said 
to have cured the fever ; it is worthy of notice that the 
patient stopped the use of the morphia during the latter 
period of the feverish attacks. Taking to it again, there 
was the same characteristic attack every week or fortnight 
at first ; gradually, however, the free intervals became 
shorter, and at the time of his admission into the Institu- 
tion the intermittent had again returned to the quotidian 



68 THE OPIUM HABIT. 

type. A treatment with large doses of quinine for several 
months, resorted to by his medical attendant, proved of 
no avail. Patient is pretty tall \ muscles and subcutaneous 
areolar tissue very well developed. Face red. Eyes 
bright. Tremor of hands, slight degree of difficulty in 
speaking. Patient shows great vivacity in talking ; his 
features move quickly ; his movements are brisk. The 
physical examination of the thoracic and abdominal organs 
shows no abnormal condition, except a considerable en- 
largement of the spleen. 

The morphia was at once withheld. 

December 21. Patient had a restless night, feels ex- 
hausted and knocked up ; yawns, complains of cold, loss 
of appetite, severe headache on moving the head, and pains 
in the back ; this is followed by nausea and at night by 
vomiting. Profuse perspiration. 

December 22. Patient was very restless in the night; 
got out of bed, ran about, laid down again, perspired 
freely, asked for morphia. The abundant perspiration 
lasted till midday and was accompanied by determination 
of blood to the head. Patient suffered from giddiness and 
felt greatly tired. Appetite poor. Frequent retching, but 
no vomiting. 

December 23. Patient has slept little. Three relaxed 
motions in the morning. Symptoms the same as on the 
previous day. New symptoms : twitchings in the extremi- 
ties, excitement, sensitiveness to the light, and epigastric 
pains. To remove the latter symptom sinapisms to the 
stomach, hot poultices and cupping (four times) were 
attended with success. Frequent vomiting. 

December 24. Patient has only slept for a few hours. 
A great deal of sneezing; eight relaxed motions. In the 
course of the day he felt well. 



GENERAL SYMPTOMS ANALYZED. 60 

December 25. The pains and pressure in the region of 
the stomach have returned and he had also palpitation of 
the heart, was very much exhausted and suffered from 
tenesmus. Two seminal emissions. 

December 26. Four relaxed motions, shivering, feels 
uncomfortable. 

December 28. Patient has only had two hours' rest. 
Hands and feet burning hot. Eight motions ; during the 
day he felt weak, complains of formication in the hands 
and feet. 

December 29. Uncomfortable feeling continuing the 
whole of the day. Patient's face was of a dark red hue; 
he complained of hypersesthesia in the feet and of cold. 
While reading a letter from his wife he began to cry, 
although the contents showed no reason for his doing so. 
Appetite good. Two relaxed motions. 

December 30. Slept from 3 to 7 a.m. Two relaxed 
motions. A great deal of sneezing, pressure in the 
epigastrium, appetite small. 

January 3, 1876. Slept from 12 to 4 a.m., after running 
about in a restless manner. Formication in hands and 
feet. 

January 6. General condition satisfactory. Appetite 
increased. 

January 14. The patient has continued to recover his 
strength. Bodily functions normal. Sexual power has 
returned. 

Urine. — During the first weeks of abstinence from mor- 
phia the urine contained albumen. 

Patient left the Institution on January 22, in perfect 
health. He has not had a relapse. 

Neuralgia of one-half of the face, in all respects like 
malarial hemicrania, I have seen in two cases. In neither 



70 THE OPIUM HABIT. 

were there other symptoms of malarial trouble. Both cases 
yielded to quinine and arsenic. 

Super-sensitiveness of the skin, sometimes of the whole 
body, more often of a limb, or a feeling of numbness, is 
not uncommon. 

A fact that I had noticed before I commenced the 
special study of this subject is, that those opium eaters who 
live past middle age usually die from paralysis. In four 
instances I have seen this. In all four cases the persons 
took laudanum. 



SUBCUTANEOUS INJECTION. 71 



CHAPTER V. 

ACCIDENTS INCIDENT TO THE SUBCUTANEOUS INJECTION OF 

MORPHIA. 

There are certain dangers attending the temporary or 
continued use of morphia by the 'hypodermic syringe that 
deserve careful attention, in order that, if possible, they 
may be remedied. The first is the production of abscess 
and inflammation. 

The majority of those who use morphia in this way are 
badly scarred. The skin is thickened, reddened and 
covered with bluish and reddish discolorations. Abscesses 
just forming, formed, or commencing to heal, are found 
here and there. Ulcers and sloughs are sometimes seen. 
Cysts are occasionally met with. Isolated patches of ery- 
sipelatous inflammation and gangrene are found in some 
instances. In the accompanying cut (p. 73) is shown the 
condition of the skin in a male nurse at Bellevue Hospital, 
who was an habitue. The photograph from which the cut 
was made was taken but a short time before death. I have 
now other patients who are quite as badly scarred. In 
the case of a young married lady, the skin, everywhere 
that the dress covered the body in front, and the limbs all 
over, was scarred, contracted and discolored, as though 
she had been badly burned and then pricked all over with 
India ink. 

Dujardin Beaumetz (quoted by Bartholow*) relates a 
case where these injuries resulted in death. 

These abscesses are due, in the majority of instances, to 
(.0) carelessness in injecting, (£) unclean needles or syringe, 

* " Hypodermic Medication/' p. 96. Philadelphia, 1879. 



72 THE OPIUM HABIT. 

(V) a dirty or over-acid solution, and (d) a low condition 
of the general system, predisposing to inflammation and 
suppuration on slight irritation. 

I have never seen but one habitue who had a clear solu- 
tion of morphia, and he made it up fresh each day. 
Abundant testimony as to the production of inflammation 
and abscess from the above mentioned causes can be found 
in my little work on " Morphia Hypodermically." 

Those patients who exercise great care in regard to 
cleanliness and manner of injecting are rarely troubled 
with abscess. Thus one patient of mine had used morphia 
subcutaneously in large amount, for over six years, inject- 
ing every time, and that several times daily, into a spot 
upon one thigh, that could be covered by a small tea- 
saucer, and has never yet had either inflammation or 
abscess. 

Indeed, some persons who exercise no care whatever to 
keep syringe or solution clean, are free from this trouble- 
some complication. Such a case is related by Dr. Roberts 
Bartholow, as follows: " One of the most inveterate sub- 
jects I have ever encountered was a man living in the 
wilds of Texas, who used a glass hypodermic syringe, that 
had been broken many times, and mended with successive 
deposits of sealing wax, until only the rusty old needle 
remained in view, and yet he escaped all accidents." 

Magendie's solution is that most commonly used. It is 
of the strength of sixteen grains of sulphate of morphia to the 
ounce of water, a few drops of acid being added to dissolve 
the drug. The solution made after the plan of Dr. H. M. 
Keyes is excellent. It will keep for a long time unchanged. 
He writes as follows: " Some years ago, while attached 
to the Roosevelt Hospital, in New York city, after repeated 
experiments with various tests and anti-ferments, I became 



SUBCUTANEOI S [NJEC HON. 



73 




74 THE OPIUM HABIT. 

convinced of the practicability of making a solution of the 
sulphate of morphia, of the strength of Magendie's, with- 
out the aid of acid, except salicylic, and that not as a 
solvent, but as a preventive of decomposition, making a 
solution that, when properly prepared, gave perfect satis- 
faction after years of use, never causing abscesses, as is 
frequently the case when the mineral acids are used, and 
when carried in the pocket for months being in as perfect 
condition for use as when freshly prepared. 

" The following directions, if followed, will give the 
desired result : — 

Sulphate of morphia, 256 grains 

Salicylic acid, 8 grains 

Distilled water, 16 fluid ounces. 

" Heat the water in a porcelain capsule, over a spirit 
lamp, until the boiling point is reached \ add the powders 
and stir with a glass rod, until they are dissolved. Filter 
through coarse filtering paper, while hot, and keep in a 
glass-stoppered bottle of green glass." 

Some physicians use carbolic acid, some chloral hydrate, 
some benzoic acid, and some chloroform, as preservative 
agents. Any of these substances, present in sufficient 
amount to prevent decomposition and clouding of the 
solution with minute vegetable growths, are apt to be irri- 
tating. In my first "work on morphia, a full list of the 
solutions used in this and other countries will be found. 

Erysipelas sometimes results from the subcutaneous use 
of morphia. 

The syringe needles are sometimes broken off in the 
flesh. This is, however, a rare occurrence. 

The method of making an injection, undoubtedly, has 
something to do with the occurrence of abscess. The 
usual plan is to pinch up a fold of skin and pushing the 



SUBCUTANEOUS INJECTION. 75 

needle in quickly, inject the solution slowly, beneath it. 
Some persons prefer to plunge the needle deep into the 
muscular tissue. It is claimed for this plan that abscess 
seldom occurs, and there is certainly less liability of wound- 
ing a vein. 

The following is taken from my book on " Morphia 
Hypodermically," and illustrates very fully another 
danger sometimes attending the use of the drug in this 
way : — 

Articles have, from time to time, appeared in various 
medical journals, at home and abroad, detailing certain 
alarming symptoms following immediately upon the in- 
jection, subcutaneously, of moderate doses of morphia. 
Such accidents have been ascribed by most authors, to the 
entrance of a needle into a vein, with the consequent sud- 
den passage of the drug into the circulation ; by some, to 
the injection of a bubble of air into the vein ; by others, 
to fright attendant upon the dread of the operation and 
the prick of the needle ; and by still others to the rapid 
absorption of the remedy when a vein is not punctured. 
Which of these hypotheses is the correct one it is at pres- 
ent difficult to decide ; perhaps each may have proved a 
factor at certain times or in certain cases. The weight of 
opinion would seem to favor the idea of sudden entrance 
of the drug into the circulation by puncture of a vein. By 
a careful study of some of these cases we may be able to 
come to a definite conclusion. 

Dr. M. E: Woodling, of North Branch, Minn., writes : — 
" My first case in which the hypodermic injection of morphia 
was tried, resulted as follows : Patient large, strong and ro- 
bust-looking man. Complained of pain in the course of the 
sciatic nerve, and of lumbago. Injection given back of 
the trochanter major, patient sitting; given slowly. I 



76 THE OPIUM HABIT. 

turned to lay the syringe on the table, when the patient 
appeared unsteady, straightened rather rapidly and persist- 
ently, and slipped from the chair, falling full length, 
supine, upon the floor, pale and with absent respiration. 
He was now perfectly limp. No response to shaking or 
questions. Spoke the word ' breathe,' loudly, in his ear. 
This he obeyed. Repeated this for about a minute, and 
in another he was able to sit up, but was very sleepy and 
unsteady, requiring assistance. In about five minutes he 
was able to stand, and I took him out on the street and 
walked around with him for an hour. I then took him 
home, still sleepy, but improving. The next morning he 
was all right, but the pain was only partially relieved. 
Other injections were given, with no bad consequences." 

Dr. A. Atkinson, Professor Materia Medica, College of 
Physicians and Surgeons, Baltimore, in reply to my fifth 
query, writes: " Never had death to result, and but one 
accident, and that was apparent suspension of animation 
for about fifteen minutes, in a young lady, very anaemic, 
in whose case I injected one -eighth of a grain of the sul- 
phate of morphia (the regular Magendie's solution) into 
the rectus muscle of the abdomen, at the repeated and 
urgent entreaties of the patient, to relieve an obstinate 
uterine neuralgia. She recovered from the neuralgia and 
from the effects of the morphia in three-quarters of an 
hour. I had, a year before, injected one-fourth of a 
grain into the arm of this same patient, for cardiac neural- 
gia, with complete relief of the pain in one hour, and with 
no bad effects. ' ' 

Dr. E. Jones, of Cincinnati, has kindly written me and 
inclosed an article* of his, bearing directly upon this sub- 

* " Some Observations on the Deep Injection of Morphia." Cincinnati Lancet 
and Clinic, August ioth, 1878. 



SUBCUTANEOUS INJECTION. 77 

ject. In it he says : " Did the needle enter an abdominal 
vein ? Several times. The first time I became somewhat 
alarmed ; the patient at once threw up her arms, com- 
plained of suffocation, giddiness, excessive fatigue, a severe 
tingling sensation following the course of the circulation. 
The countenance was at first livid, then flushed ; the eyes 
became unusually brilliant ; slight muscular twitchings, 
profuse sweating, with cold extremities, and in a few mo- 
ments complete relaxation was followed by deep sleep, 
which lasted only four hours, when she awakened, feeling, 
as she expressed it, ' ever so much better.' 

" The same accident occurred three times, the symp- 
toms much milder, with the exception of a burning sensa- 
tion of both eyelids of either eye and both lips, which at 
one time became painfully intense. The above symptoms 
were produced by an injection of five grains of sulphate of 
morphia into an abdominal vein. 

" Being unable to see her for a day or two, I requested 
my friend, Dr. Geo. E. Walton, who had watched the 
case with a good deal of interest, to call and give her an 
injection of two grains, when she put both hands to her 
head and gave a cry of excruciating agony. A sharp pain 
darted through her head, which lasted ten or fifteen min- 
utes ; also complained of an intense itching of nose and 
lips, finally passing off, leaving no deleterious effects. The 
same accident occurred to myself, only in a less degree. 
These injections were also made in the abdomen." 

The patient was a German woman, aged thirty-seven, 
and weighing about 135 lbs. The case was presumably 
one of fecal accumulation in the colon, with severe abdom- 
inal pains. 

Dr. W. A. Neal, of Dayton, Michigan, writes in this 
connection as follows: " No deaths ; the only accidents 



78 THE OPIUM HABIT. 

were where a vein was punctured. This produced dysp- 
noea, great distress, and was usually followed by a chill 
and the reaction by fever ; but in every instance there has 
been but one chill, and fever once, lasting three or four 
hours." 

Edward T. Wilson, m.b., Oxon., f.r.c.p., Lond., who 
has a valuable and interesting article on the subcutaneous 
injection of morphine, in the St. George's Hospital Re- 
ports, for 1869, writes me as follows: " Never either 
death or accident. Nothing beyond a temporary feeling 
of faintness, and on two occasions a temporary outburst of 
urticaria, which soon passed away. ' ' I hardly think these 
phenomena were due to injection into a vein ; indeed, the 
writer does not endeavor to account for them on this ground. 
They partake more of the nature of rapid absorption 
with some idiosyncrasy. Dr. E. C. Seguin makes 
mention, in the New York Medical Record, of a lady thus 
affected (urticaria) by any preparation of opium taken by 
the mouth. 

Arthur R. Graham, m.d., etc., of Weybridge, England, 
sends me the following interesting and conclusive case : 
" No deaths; but one alarming accident worth recording : 
I had injected a large dose (probably three-quarters of a 
grain) into the right forearm of a woman whom I was in 
the habit of injecting daily. Almost immediately she 
started up, and holding up her left hand and looking at it, 
exclaimed, ' O, how funny my fingers feel ! ' and fell back 
in a dead faint, with blanched lips. I immediately bound 
a tape tightly around the arm, above the puncture, and 
then gave brandy and asafcetida injections, but she re- 
mained unconscious, I think, for more than half an hour. 
After she was sufficiently recovered to talk rationally I 
loosened the tape, when she immediately fainted again. 



SUBCUTANEOUS INJECTION. 79 

Of course, I at once tightened the ligature and kept it so 
for some hours. The second swoon was less alarming than 
the first. In the first no pulse could be felt, nor could the 
heart sounds be heard, excepting with great difficulty. 
My impression at that time was that, had I not applied the 
ligature at once I should have had a fatal result to chron- 
icle. It was the impulse of the moment to tie on the 
tape, and had I had time to reason I should have rejected 
the idea as an entirely useless one ; but in any similar 
emergency I should now recommend any one to try it." 

Dr. E. Fletcher Ingalls*, who has devoted much atten- 
tion to the hypodermic injection of morphia, reports the 
following case : " I have often used hypodermic injections 
of morphia, and always with good results, until a few weeks 
since, when I obtained alarming results from the adminis- 
tration, by this method, of one-fourth of a grain of mor- 
phia. 

" The patient, in consequence of continuous watching 
with sick children, had become debilitated, and, as a 
result, suffered at times from severe pains of a neuralgic 
character. I was called in the night to see her in one of 
these attacks. The pain had commenced about twelve 
hours previously, and with frequent exacerbations, had 
steadily increased in severity until it had become unbear- 
able. 

"I dissolved one-fourth of a grain of morphia in pure 
water, and administered it under the integument on the 
outer side of the arm. Within a few seconds the breath- 
ing became stertorous, the pulse failed, the lips and coun- 
tenance became livid, and the eyes were set ; respiration 
ceased, the radial and cardiac pulsations were lost, and 
the heart sounds could not be distinguished. The woman 

* Chicago Medical Journal and Examiner, Aug. 1877. 



80 THE OPIUM HABIT. 

was to all appearances dead. How long this condition 
continued I cannot tell ; it seemed an age, but was prob- 
ably only ten or fifteen seconds, for by prompt means I 
succeeded in resuscitating my patient. 

"After a few minutes she expressed herself as much 
relieved. I remained with her some time, and then left 
careful directions with the husband in case any other 
unfavorable symptoms should occur. During the next few 
hours the patient fainted twice, but she was restored by 
dashes of cold water in the face." 

Dr. H. L. Harrington, of Little York, 111., refers me to 
the report of a case* of his, which reads as follows : " Was 
called a short time since to treat W. S., male, aged sixty- 
two, for acute dyspepsia (bilious attack) accompanied by 
very severe pain. Administered hypodermically, in the 
hypogastric region, morphiae sulph. 0.02 gram. Before 
the syringe was emptied alarming syncope supervened, 
and occurred twice, at intervals of ten or fifteen minutes. 
Stimulants administered freely, artificial respiration and 
the use of electricity were successful in reviving the 
patient. Neither narcotism nor coma were in any degree 
present. Is it possible to attribute the syncope to the ef- 
fects of the drug ? Not over fifteen seconds were occupied 
in the operation." I think this an excellent example of 
the puncture of a vein with entrance of the drug directly 
into the circulation. 

Dr. Aug. M. Tupper, of Rockport, Mass., published the 
following interesting case :f 

"On the morning of the 22d ult. I was called to see Mr. 
G., who was stopping at one of our hotels. I found a 
healthy-looking young man, about thirty years old, suffer- 

* Chicago Med. yournal and Exami7ier, April, 1879. 

f Boston Medical and Surgical yournal, October 30th, 1879. 



SUBCUTANEOUS INJECTION. 81 

ing from lumbago, confined to his bed, and in consider- 
able pain, aggravated very much by movement. Applica- 
tions of mustard and an anodyne liniment were prescribed. 
In the evening I called again, and as the relief was slight, 
decided to inject some morphia directly over the seat of pain, 
a method I have found very efficacious in similar cases. Ac- 
cordingly I injected nine drops of a solution of sulphate of 
morphia, one grain to a drachm of water, into a spot mid- 
way between the spine and crest of the ilium. As is my 
custom, the solution contained one drop of carbolic acid, 
which I added in order to keep it. In five minutes he 
expressed himself as feeling relieved, and sat up in bed to 
show us the improvement. I told him to lie down and 
keep still awhile, and he did so. We chatted pleasantly 
for perhaps five minutes longer, when, turning toward his 
wife, he said, ' I think I am going to vomit,' and turned 
to the side of the bed. I noticed that he looked a little 
pale, and before Mrs. G., could get the basin, he grew 
deadly pale, his eyes rolled up in his head so that only the 
whites were visible, the jaws were clenched, the head was 
drawn back, and the whole body stiffened, respiration 
ceasing also. I immediately went to him, dashed cold 
water in his face, and took the wrist to feel his pulse, 
which, to my horror, was not to be felt. He was in this 
state for perhaps a minute. I then raised him up, and 
looking into his eyes, which were staring wide open* saw 
that the pupils were widely dilated. Very "soon the color 
began to return to his face, he was drenched with perspi- 
ration, and recovered consciousness. I laid him back on 
the bed, and he looked up, smiled, and said, ' I'm all right 
now.' The pulse was quite full at sixty, but inclined to 
be irregular. I gave him brandy freely, and he- had no 
further trouble, but the pulse remained at sixty for the 



82 THE OPIUM HABIT. 

next twenty-four hours ; he said it was usually about eighty. 
I cannot verify that, for he left town the following day. 

" That was certainly a very unusual effect from such a 
dose, a little over one-eighth of a grain. The question 
arose in my mind whether the acid could have had any- 
thing to do with it ; but I have given the same mixture a 
great many times without the slightest trouble. I may add 
that the solution was prepared that morning, and I injected 
the same dose into the same part of the body, for neural- 
gia, in a female patient, that very same day, previous to 
using it on this patient. I should not care to repeat this 
operation on Mr. G., and advised him never to have it 
done again. I would also state that it relieved his lumbago, 
for the next afternoon he was dressed and down at his meals. ' ' 

After seeing the report of this case I wrote Dr. Tupper, 
who has courteously furnished me with the following ad- 
ditional facts : ' 6 My patient, I should say, was of a phleg- 
matic temperament. He had taken no medicines by the 
mouth before I saw him, nor while under my care. He 
had never taken any narcotic in his life, he says. The 
pupils were natural very soon after the effects of the dose 
ceased. He writes me that his pulse remained at sixty for 
a week, but that he felt first rate. Pulse rate since then has 
been seventy-six. It seems to me that it must have been 
a peculiar susceptibility to this drug in his case, else it 
would not have had such a lasting effect upon the pulse. 
I do not think it was due to the mode of administration.. 
He related to me afterward, that a cousin (I think that 
was the relation) had very peculiar and even dangerous 
symptoms from a dose of Dover's powder, some time ago, 
and that the physician in attendance was detained all 
night in consequence. This would go to show an idiosyn- 
crasy in the family." 



SUBCUTANEOUS INJECTION. 83 

I think that the doctor is right with reference to idio- 
syncrasy, but I think, also, that the method of administer- 
ing the drug had much to do with it. As I have said 
before, where an idiosyncrasy, be it to narcotism or any 
other peculiar manifestation, exists, the sudden entrance 
of the drug into the system is certain to aggravate those 
symptoms; may, indeed, call forth an idiosyncrasy that 
the drug given by the stomach would, possibly, never have 
revealed. The fact that some ten minutes elapsed between 
the time of the injection and the first appearance of the 
alarming symptoms seems to preclude the idea of the 
needle having entered a vein. The symptoms are, how- 
ever, exactly those that are seen when a vein is punctured. 
As will be seen from the results of experiments soon to be 
recorded, and from the conclusions arrived at by the 
Committee of the Medico- Chirurgical Society* of Eng- 
land, five minutes is abundant time for enough of the drug 
to be absorbed to produce its characteristic, and, there- 
fore, its unusual effects, where idiosyncrasy exists. 

Prof. H. C. Wood,f states that he has seen deep coma 
produced in three minutes by a hypodermic injection of 
morphia. This may have been due to unusual rapidity of 
absorption from the cellular tissue, or to direct injection 
into a vein. 

Here is a somewhat similar case j : A lady, aged twenty- 
four, who has been a sufferer from neuralgia every day for 
months, was given a hypodermic injection of one-fourth of 
a grain of the hydrochlorate of morphia in the subcuta- 
neous tissue of the leg. Alarming syncope and extreme 
prostration came on within five minutes after the injection 
was made. The patient was not out of danger for four 

*" Medico-Chirurgical Society Trans.," vol. l. 

t " Materia Medica and Therapeutics," Phila., 1877, p. 205. 

% "Medico-Chirurgical Transactions," vol. l. 



84 THE OPIUM HABIT. 

hours after, and was too ill to leave her bed for two weeks. 
The neuralgia did not return for some months. 

Dr. Francis H. Miller, of East New York, formerly 
House Surgeon of St. Peter's Hospital, Brooklyn, writes 
me : " Several times, when I suppose my fluid entered 
some small vein, the patients complained of sudden weak- 
ness, faintness and dizziness, and almost syncope." 

Dr. Samuel W. Francis, of Newport, R. I., writes me : 
' ' I have heard of two or three cases where extreme syn- 
cope set in, the patients being restored only with great 
difficulty." 

Dr. J. S. Jewell, Professor of Nervous and Mental Dis- 
eases, Chicago Medical College, writes me: "I have 
never had any serious consequences follow morphia injec- 
tion, but have seen temporary unpleasant symptoms (vaso- 
motor disturbances), vertigo, mental confusion, etc., a few 
times." 

Dr. Geo. R. Fowler,* of Brooklyn, states that he has 
twice had alarming symptoms from puncturing a vein. He 
believes that this may be avoided by making the skin of 
the part to be punctured tense, and introducing the 
needle at a right angle to the axis of the limb. 

Prof Nussbaum,f of Munich, has published an interest- 
ing account of an accident that happened to himself. He 
had made use of the hypodermic method of giving mor- 
phine to himself, as often as 2000 times, using sometimes 
as much as five grains of morphia at an injection. One 
day he accidentally injected two grains of the acetate of 
morphia into a vein, and did not recover from the dan- 
gerous effects for two hours. He has seen the same symp- 
toms, in a less degree, in two of his patients. He advises 

* N. Y. Medical Record, Aug. 15th, 1874. 
^Medical Times and Gazette, Sept. 23d, 1865. 



SUBCUTANEOUS INJECTION. 85 

stow injecting, and withdrawal of the piston if a vein is 
punctured. 

The following interesting remarks are clipped from an 
English journal,* and bear directly on the question in 
hand : — 

' ' ' Observer ' remarks that ' Spectator, ' in the Journal, 
of April 1 2th, very accurately described what always 
happened when a vein has been pierced and morphia in- 
jected into it, although he might have added (as no doubt 
it occurred) that the person injected also experienced a 
strong taste of morphia ; and probably, also, an unusually 
large quantity of blood flowed from the puncture. It is a 
very serious accident to inject morphia into a vein, but it 
need never happen, if the operator, thrusting the instru- 
ment under the skin, will draw up the piston, when, if the 
point be in a vein, blood will be drawn into the syringe. 
' Observer ' knows a gentleman who for years has been in 
the habit of injecting himself with morphia, three and 
four times a day, to whom the accident has frequently 
occurred, accompanied by the symptoms described by 
6 Spectator. ' He is much alarmed at the time, and is after- 
ward careful to draw up his piston, but in three or four 
months he begins to be less cautious, until he gets another 
reminder. As to the necessity of drawing up the piston, 
there cannot be two opinions ; for besides the symptoms 
certain to follow the introduction of morphia directly into 
a vein, there is the danger of air entering as well, should 
care not be taken to prevent it. ' Observer has known an 
habitual morphia taker by injection to contract albumin- 
uria. The albumen would greatly diminish on the daily 
quantity of the injection being lessened, and entirely dis- 
appear in forty-eight hours, when the morphia was wholly 
discontinued. 

* British Medical Journal, May, 1879. 



86 THE OPIUM HABIT. 

" ' Injector ' was, until very lately, for nearly two years, 
one of the victims of morphia, and during that time he 
five times thoroughly, and twice partially, experienced 
more or less of the horrible symptoms sketched by ' Spec- 
tator ' in the Journal of April 12th. The sensations were 
as follows: 1. A dull, gnawing pain in some decayed 
teeth, accompanied by a metallic taste in the mouth. 2. 
A pricking and tingling of the forehead and cheeks, 
somewhat like prickly heat ; but this soon increased, 
spreading to the ears, neck, arms and chest (but not below 
the waist, although the morphia was injected into the calf 
of the leg). This pain soon became almost unbearable, 
but it was entirely eclipsed by what ' Spectator ' calls 
' throbbing,' but which ' Injector ' says would be better 
represented by imagining twenty blacksmiths confined in 
his head, with each an India-rubber-headed sledge ham- 
mer, and each trying to make the best of his way out. 
Imagine, at the same time, that you are suffering from the 
first mentioned broiled feeling ; that your skin feels as if 
about to burst ; your eyes as if already started from their 
sockets ; your lips as if they did not belong to you — then 
you may have a faint idea of what ' Spectator' wishes to 
describe, and what I, who have five times felt it, yet feel 
powerless to lay before you as I ought." He had always 
thought that this condition was caused by : 1, too rapid 
injection ; 2, too much at once ; 3, the solution being too 
strong ; and 4, by its being injected directly into a toler- 
ably large vein. When the symptoms have occurred, he 
has always noticed that injection has taken place at one of 
two spots — probably into the same vein each time in each 
leg — one on each leg. Again, it only occurred when he 
had to inject a large quantity in a short time ; and he 
always used a very strong solution of acetate of morphia 



SUBCUTANEOUS INJECTION. 87 

(forty grains to the half-ounce of water). He advises that 
when one feels any of the symptoms coming, he should 
walk about as rapidly as he can. He has relieved his worst 
attacks in this way, and has warded off others by violent 
exercise in his room, as soon as he felt the pain in his 
teeth, or the metallic taste or the " prickly heat." He 
thinks that corroboration of his belief as to the cause of the 
symptoms is afforded by Dr. Pepper's description of the 
results of injecting milk into the veins of anaemic patients. 

The case referred to by "Observer" reads as follows:* 
" Scarcely- has the fluid left the syringe when the most in- 
tense feeling of irritation and pricking is felt in the skin, 
spreading from the puncture rapidly all over the body. At 
the same time the skin becomes suffused with a bright blush. 
The heart's action then becomes greatly quickened, and 
there is a throbbing, rushing feeling through the head. 
The hands are somewhat swollen and the lips get a glazed 
appearance. In one case that I had, the patient became 
suddenly unconscious, as if knocked down by the sudden 
shock; and in all the cases where these symptoms have 
appeared the general disturbance has been very great and 
the attack of a severe character. The symptoms generally 
subside gradually, leaving behind great pain in the head. 

This gentleman gives these as the main symptoms of 
several such accidents that have occurred in his practice, 
and characterizes their occurrence as something novel and 
important. 

Dr. J. A. Houtz,f of Logansville, Pa., who is a staunch 
advocate of the hypodermic method, says : " The greatest 
danger is in injecting into a vein sufficiently large to carry 
the whole dose at once into the circulation. That can be 

* British Medical yournal, April 12th, 1879. 

t Philadelphia Med. and Surg: Reporter, Oct. 18th, 1879. 



00 THE OPIUM HABIT. 

avoided by selecting a place where the large veins are least 
numerous, and by injecting, say a third of a dose, and 
then waiting eight or ten seconds, when, if in a vein, 
the symptoms will show themselves. The first symptoms 
are a feeling of great fullness of the head and intense 
flushing of the face, coming on within a few seconds after 
the operation. Such, at least, was the case in a patient of 
mine." 

A case of syncope and prostration is reported by Dr. E. 
Wenger, of Gilman, 111. The amount of morphia used is 
not stated. 

F. Woodhouse Braine, f.r.c.s., etc., publishes the fol- 
lowing case:* " Mrs. H. C, aged thirty-five, in good 
health otherwise, had been kept awake seventy-two hours 
by intense neuralgic pain on left side of head, face and 
neck, arising from a carious molar tooth on the left side of 
lower jaw. She was injected with one-third of a grain 
of acetate of morphia. At i a.m., on June 28th last, the 
morphia, dissolved in about four drops of water, was intro- 
duced under the skin of the left arm, just over the inser- 
tion of the deltoid. No blood appeared at the puncture. 
In about fifteen seconds tightness of the chest and diffi- 
culty in breathing was complained of, and the patient 
asked to be raised, saying she felt as if she was dying. Her 
face and lips now became pale ; speech became indistinct 
(not inaudible) ; pulse irregular ; some spasm of the facial 
muscles took place, and she fell, to all appearance, dead. 
Cold water was freely dashed over her face and chest, and 
as she was unable to swallow, her tongue was rubbed over 
with sal volatile, and ammonia applied to her nose, artifi- 
cial respiration being kept up at the same time. During 
this time her face was blanched, pulse not to be felt, and 

* Med. Times and Gazette, Jan. 4th, 1868, p. 8. 



SUBCUTANEOUS INJECTION. 89 

respiration not to be perceived. Insensibility continued 
for about three minutes ; then, happily, one or two feeble 
beats of the pulse, and a shallow inspiration or two, showed 
returning animation. She then became conscious ; pulse 
feeble but regular ; respiration slow ; fingers remained 
numb and both thumbs were firmly drawn into the palms 
of the hands. This passed off in about six minutes, leav- 
ing her feeling very ill, but free from the neuralgic pain, 
which did not return. There was no feeling of nausea, 
and no attempt at vomiting during any part of the time. ' ' 
Mr. Arthur Roberts* publishes the following cases : — 
" Sir: — The case described by Mr. Braine, in your last 
week's journal, of an unusual effect of subcutaneous injec- 
tion, is what I have seen in two instances, but nothing like 
to such an alarming extent. One was in a gentleman 
whom I had injected several times previously, the other in 
a lady. I have also partly noticed it when I have injected 
myself. In the first case, a few minutes after the opera- 
tion, the face became intensely flushed ; this was followed 
by vomiting, and then a dead faint and struggling for 
breath, the pulse scarcely perceptible. These cases, and 
the effect on myself, taught me, when injecting a patient 
for the first time, never to give more than the sixth of a 
grain — wait a quarter of an hour longer, and then give the 
remainder of the dose, after ascertaining how the first 
injection was taking effect. Women, I have found, are 
generally bad subjects for subcutaneous treatment ; for 
they get frightened and nervous — in fact, one woman told 
me that though the morphia taken by the skin did her 
more good than by the mouth, yet she preferred the latter, 
for the instrument frightened her. I have used my needle 
over three hundred times, and I have always noticed one 

* Medical Times and Gazette, Jan. nth, 1868, p. 53. | 



90 THE OPIUM HABIT. 

fact, that if the wound bleeds after the operation the mor- 
phine enters the system much more powerfully and rapidly ; 
and I always know when it is going to bleed, by the opera- 
tion giving a good deal of pain. When this is the case I 
withdraw the instrument, to see if the puncture bleeds ; if 
it does, I try a fresh place. ' ' 

Bartholow,* in his useful and able little work, calls at- 
tention to this danger in these words : " In practicing the 
hypodermic injection it is important to avoid puncturing a 
vein. Serious depression of the powers of life, fainting 
and sudden and profound narcotism have been produced 
by injecting a solution of morphia directly into a vein. 
Fatal collapse might be induced by injecting air into a 
large vein, along with the solution." 

Syncope, etc., as we have seen, from this cause, is com- 
mon ; narcotism rare, the drug seeming to exhaust itself in 
its initial action, or to produce a condition of the system 
in which narcotism is wholly or partially impossible. 

Dr. Coronaf {Giornale di Medicina Militaire), summing 
up the results of his experiments on animals, says: " The 
injection of the two poisons (morphia and atropia) into 
the veins showed that a much smaller dose was sufficient to 
produce rapid and grave poisoning, but even then the 
morphia produced its action instantaneously, and its action 
always superseded that of atropia. ' ' 

J. Pennock Sleightholme, l.r.c.p., Lond.,J reports the 
following case : " A young man of sound constitution and 
good health, who had never before taken morphia hypo- 
dermically, partly as an experiment and partly with the 
hope of relieving some slight restlessness, injected himself, 
at about 3 a.m., with one-sixth of a grain of morphia. 

* " The Hypodermic Method," Philadelphia, 1879, P- 3 2 - 

f Edin. Med. Journal, Dec. 1876. Practitioner , 1877, p. 132. 

% Practitioner , July, 1871, p. 25. 



SUBCUTANEOUS INJECTION. 91 

Immediately after the injection he fell down on the floor 
in a state of syncope, and had slight convulsive movements 
on one side of the body ; consciousness did not entirely 
leave him, and after lying still for about ten minutes he 
was sufficiently recovered to be able to go to the next room 
and help himself to a couple of glasses of sherry. After 
this the feeling of faintness gradually passed off, and he 
slept for about two hours, but on rising, at eight o'clock in 
the morning, the same feeling of faintness returned, accom- 
panied with great pallor. These symptoms were relieved 
by a dose of brandy, but did not entirely cease until noon 
the same day." 

A physician in the South, who is a slave to this habit, 
writes me : " Several times I have been unfortunate enough 
to puncture a vein, and to introduce some of the solution 
directly into it. Immediately I feel a peculiar tingling all 
over me, from the tips of my fingers to the ends of my 
toes. The skin of my head feels as if a myriad of pins 
were penetrating it. This feeling passes off in from three 
to five seconds. Sometimes it has been followed by a tur- 
gescence of the vessels of the brain, causing a great fullness 
and throbbing, with slight headache following." 

In a most interesting and instructive letter from Dr. 
Wm. W. Cable, of Pittsburg, Pa., I find the following: 
"I have spoken of minor accidents which sometimes oc- 
curred. In all that I have seen they were caused by the 
injection of the morphia directly into a vein. A series of 
phenomena instantly take place. The patient describes 
the first sensations as the stinging of bees all over the body, 
with difficulty of respiration, and intense congestion and 
swelling of the face and body. In one case that I saw the 
face was so swollen that in five minutes all traces of the 
natural features were lost. This condition of affairs calls 



92 THE OPIUM HABIT. 

for prompt action. If possible, the patient must be kept 
in motion and applications of cold water be made to the 
face and spine. If the patient falls the limbs must be 
raised, and all methods used to keep the heart acting, for 
if you can bridge over ten or twelve minutes the patient is 
safe. To prevent being ' struck, 1 as he calls it, one patient 
of mine carries a cord, which he throws over the arm, and 
if an unfavorable symptom occurs, he uses it as a tourni- 
quet, and in a moment the result is apparent in the extra- 
vasation of the blood and the morphia from the wounded 
vessel. This is a safe condition, as afterward no rapid 
absorption can occur." 

This is a companion case to that reported by Graham, 
where ligation of the limb proved to be of great practical 
importance. 

An interesting series of experiments, bearing directly 
upon the use of the ligature in such cases, were made by 
Mr. Georges,* at the Paris Society of Practical Medicine, 
some of which were conducted for this gentleman by M. 
Claude Bernard. These experiments consisted in "in- 
jecting poisonous substances into the cellular tissue, 
with the view of showing the far greater safety and cer- 
tainty of the hypodermic method as a means of administer- 
ing, medicinally, highly-poisonous substances. He in- 
jected quantities of codeine, atropine and especially strych- 
nine, which would surely cause death in the absence of 
precautions for preventing the too rapid introduction of 
the poisons. These injections were practiced without dan- 
ger in the dog's paw, the passage of the poison into the 
veins being checked by the forcible application of a liga- 
ture around the paw. To render the experiment still more 
striking, he resolved to employ injections of the most dan- 

* Medical Times and Gazette, June 14th, 1865, p. 42. 



SUBCUTANEOUS INJECTION. 93 

gerous of poisons — curare — and M. Claude Bernard con- 
ducted them for him. A solution containing about five 
centigrams of curare (sufficient to kill more than fifty dogs 
of the size of the one operated upon), was injected into the 
paw, and in twenty minutes the animal fell on its side. 
The paw was now firmly tied, and at the end of about twenty 
minutes the animal arose. Whenever the ligature was 
loosened he again fell down, sometimes at the end of ten 
minutes, and sometimes in a shorter period* and in this 
way it became possible to dose with complete certainty, 
according to the effect desired to be produced, the quantity 
of poison to be absorbed. The next day the dog was found 
on his three paws, only suffering from the swelling caused 
in the fourth by the injections. The ligature was removed 
and he was soon all right. 

' * The same experiment performed on another dog was 
followed by the same results, the animal being caused to 
fall or rise at the end of five, ten, or fifteen minutes, 
accordingly as the paw was tied or untied. This dog, how- 
ever, next morning, on the removal of the ligature, fell 
down again, all the poison not having had time to become 
eliminated by the urine, so that it was necessary to reapply 
the ligature. M. Georges points out the superiority of the 
endermic method, when we have to administer powerful 
substances, as we may apportion the dose with an exacti- 
tude, according to the tolerance of the disease and idio- 
syncrasy of the patient, quite unattainable when admin- 
istered internally." 

Dr. Alonzo Clark, Professor of Theory and Practice of 
Medicine and Clinical Medicine in the College of Physi- 
cians and Surgeons, New York, kindly gives me the details 
of the following case : "There was brought into Bellevue 

* Italics mine. 



94 THE OPIUM HABIT. 

Hospital, some years ago, during his term of service, a 
young woman, aged about twenty-five, suffering from tris- 
mus. The jaws were so firmly locked that it was neces- 
sary to break out a tooth, in order to administer food and 
medicine. All ordinary medicine failing, on the evening 
of the second day the house physician determined to treat 
the case with hypodermic injections of morphia. He gave 
three injections of fifteen minims of Magendie's solution, 
with two hours' interval between the doses, and finding 
that no effects of the morphia were apparent at 2 a.m., he 
gave an injection of twenty minims. When he returned to 
the ward, at 4 a.m., the patient was dead. The nurse, on 
being questioned, stated that the patient was "asleep" 
before the doctor left the ward. The arm in which the 
puncture had been made was examined by Dr. Clark and 
others, and over the point of the last puncture a little discol- 
oration, as from exlravasated blood, was apparent, and 
which, on careful dissection, was found to mark the track of 
the needle, which had opened directly into a vein. 

In this case the patient probably died almost immedi- 
ately, the action of the morphia being shock-like, and its 
effect the more intense as one grain and a half had already 
entered the system by the skin. 

Prof. Wm. T. Lusk, of this city, writes me of a case of 
syncope following immediately upon the injection. No 
blood appeared at the point of puncture. 

Another case of death from injection into a vein is re- 
ported to me by Professor Willard Parker. An injection 
of morphia, to relieve the severe pain of neuralgia, was 
made into the temporal region of an apparently healthy 
young man. Death was almost immediate. The case was 
in the hands of a physician in Connecticut. I have re- 
peatedly written, asking for full particulars, but cannot get 



SUBCUTANEOUS INJECTION. 95 

them. It is a strange fact that all the cases where injection 
into the temporal or infra-orbital region is mentioned by 
correspondents and by some authors, have been attended 
by either intense narcotism or death. This is, of course, 
not a uniform occurrence, but it has happened sufficiently 
often to call our attention to it, and urge caution in its 
use in this situation. 

fti this connection, and in point of history, the follow- 
ing quaintly worded extract from a diary, which appears 
in Pepy' s Journal* of May 16th, 1664, is of interest. 
" With Mr. Pierce, the surgeon, to see the experiment of 
killing a dog by letting opium into its hind leg. He and 
Dr. Clark did fail mightily in hitting the vein, and in 
effect did not do the business after many trials ; but with 
the little they got in, the dog did presently fall asleep and 
so lay till we cut him up." 

The different effects produced by the same accident on 
different persons seems to be due to some peculiarity of 
constitution with reference to morphine. The drug is 
thrown so rapidly into the circulation that it carries every- 
thing before it, seeming to instantly overwhelm the vital 
powers. The brunt of its action seems to be exerted on 
the heart, and the key to proper treatment is thereby 
afforded. To whatever cause due, the effect is essentially 
the same, the difference being only one of degree. That 
syncope and vaso-motor disturbances are ever due to the 
injection of air into a vein with the solution, I very much 
doubt. In the first place the morphia itself is quite suffi- 
cient to produce the symptoms, and in the second place 
not more than a bubble of air is ever left, by carelessness, 
in a syringe, and this is not sufficient to produce these 
symptoms. To settle this matter, I purposely injected into 

* E. P. Wilson, "St. George's Hospital Reports," 1869. 



96 THE OPIUM HABIT. 

the median cephalic vein of my own arm* twice as much 
air as this, with a solution of warm water, and without any 
bad effects ; in fact, no effect whatever. My arm, above 
the point of puncture, was protected by a ligature that 
could have been drawn tight at a moment's notice, had 
there been any untoward symptoms. The following day I 
injected one-sixteenth of a grain of the sulphate of morphia 
into another vein, with the effect of producing sudden 
dizziness, a feeling as if the head would burst, pricking 
and tingling of the nose, suffusion of the face and eyeballs, 
dilatation of the pupils, faintness and nausea. The pulse 
was first greatly accelerated, and then fell to about 65, and 
remained so all that day. My pulse in health is 74. This 
was done at 10.30 a.m., and I did not fully recover until 
about 3 p.m. It may be well to state that morphia, either 
by the mouth or skin, always has a very unpleasant effect 
on me, while opium has not. Instead of causing sleep 
and soothing irritation, the former makes me nervous, - 
" twitchy" and somewhat light-headed. In both cases the 
needle entered the vein, as it was made prominent by the 
ligature, and blood appeared at the point of puncture. As 
soon as the injection was made the ligature was loosened, I 
being ready to pull it tight at a moment's notice. 

M. Calvet* presents a physiological research of the action 
of morphine upon the various functions of the organism. 
A clinical study of morphine as a therapeutical agent, 
especially in the relations of acute to chronic morphinism. 
In the first he observes that both intravenous as well as 
subcutaneous injection of the hydrochlorate of morphine 
accelerates respiratory movements, succeeded by a period 
of retardation, and produces sometimes a momentary arrest 
or respiratory syncope. The same relative effects occur 

* " These de Paris," N. V. Med. Journal, Sept. 1877. 



SUBCUTANEOUS INJECTION. 97 

with the cardiac movements; at first accelerated, followed 
by retarded pulsations ; sometimes even by cardiac syncope. 
During this time animal heat exhibits analogous pheno- 
mena, namely, the elevated is followed by lowered tem- 
perature. In fact, the absorption of morphine, whether 
by intravenous or subcutaneous injection, produces a very 
marked influence upon the reflex actions. In certain cases 
the period of exaltation does not occur, but the temperature 
becomes lowered, and the respiratory and cardiac move- 
ments are slower. Though he has not finally completed 
his researches, M. Calvet advances the opinion " that the 
above phenomena are the dyspnoea, dizziness, etc., some- 
times seen during the operation of intravenous injection 
of milk." A study of these cases* (milk injections) shows 
us that these phenomena rarely if ever present themselves 
until a large bulk of fluid (from two to six ounces) has been 
added to the blood, and that, therefore, the argument does 
not hold good. 

An interesting and novel series of careful experiments on 
man and animals, made by Dr. Gaspar Griswold,f then 
house physician in Bellevue Hospital, this city, although 
not made with that end in view, seem to demonstrate very 
clearly that a powerful and possibly irritant medicine (aq. 
ammonia dil.) when injected into a vein in quantity does 
not produce any untoward symptoms, but, on the contrary, 
were always found to have the happiest, and sometimes a 
most marvelous effect. 

Another question arises here : Is it possible for such 
phenomena as have been ascribed to the injection of 
morphia into a vein to take place without such puncture ? 

* Pepper, N. Y. Medical Record, Nov. 16th, 1878. H. H. Smith, Ibid. Joseph 
H. Howe, Ibid., Dec. 7th, 1878, and Jan. 4th, 1879. J. S. Prout, Ibid, May nth, 
1878. 

f "The Intravenous Injection of Ammonia," N. Y. Medical Record, June, 1879. 



98 THE OPIUM HABIT. 

I think so. Some of the cases reported would seem to 
prove it; notably that by Dr. Tupper, where the symp- 
toms did not appear until ten minutes after the injection 
was made. Every insertion of a hypodermic needle, of 
necessity, cuts across or opens a number of capillary ves- 
sels, to which is undoubtedly due, to a certain extent, 
the rapidity of absorption when drugs are given in this 
manner. The Committee of the Medico-Chirurgical So- 
ciety* came to the conclusion, from experiments on men 
and animals, that absorption of a sufficient amount of the 
remedy to produce decided symptoms took place in from 
four to ten minutes. 

" Experiments on a healthy man, aged thirty-two. One- 
sixth of a grain of acetate of morphia was employed : — 



Symptoms. 


Skin. 


Mouth. 


Absorption 


5 min. 


1 10 min. 


Pulse increased . 


. 8 beats. 


None. 


Pulse lowered 


12 " 


10 beats. 


Headache . 


. 36 hours. 


10 hours. 


Nausea .... 


46 " 


3 " 


Pulse, its nat. standard 


. 22 " 


8 " 


Incapacity to work 


7 " 


None. 


Total duration of symptoms 46 " 


11 hours. 



I have found that some drugs, notably jaborandi, when 
used hypodermically, manifest their peculiar symptoms in 
so short a time as one minute, no vein of any size being 
punctured. It is to be supposed that one drug is absorbed 
from the subcutaneous cellular tissue with about the same 
rapidity as another, but that each drug manifests its presence 
in the circulation with a difference in point of time, ac- 
cording to its peculiar action, or to some idiosyncrasy of 
the patient. Thus, while morphia may be absorbed as 
rapidly as pilocarpine or jaborandi, it does not, save in 

* " Medico-Chirurg. Transactions/' vol. l. p. 570. 



SUBCUTANEOUS INJECTION. 99 

certain persons or at certain times, give evidence of its 
presence by recognizable symptoms so early or so decidedly 
as the latter, unless the patient manifests some idiosyncrasy. 

From this it would appear possible, in certain cases, for 
a very rapid absorption to take place, and sudden over- 
whelming of the heart by the drug to occur without the 
puncture of a vein. As the needle does not go deeper than 
the subcutaneous cellular tissues, in a large majority of the 
cases the immediate treatment would be as effective in 
one case as in the other. 

At a recent meeting of the New York Pathological 
Society,* Dr. Amidon presented some microscopic speci- 
mens exemplifying the pathology of hypodermic medi- 
cation. He said that although hypodermic medica- 
tion had been in vogue twenty-five years, or according 
to the claims of some, forty years, he was not aware 
of any accurate investigation of the relations between 
the hypodermically injected mass and the skin. He had 
injected Prussian blue (a weak solution) into the skin 
of moribund subjects, and a portion of skin was excised 
after death. The hypodermic injection was given in 
what he considered the best manner, namely, the pinching 
up a fold of skin and introducing the needle horizontally. 
The hypodermic injection was found to occupy a space 
three and a half centimetres in diameter and one milli- 
metre in thickness, tapering in shape. The location of 
the hypodermic injection varied according to the amount 
of adipose tissues in the subject. In those who had but 
little adipose tissue the hypodermic injection remained 
immediately below the skin, while in those who had much, 
the injection diffused itself. It would be seen in the 
specimens presented that the hypodermically injected mass 

*New York Medical Gazette, Jan. ioth, 1880. 



100 



THE OPIUM HABIT. 



lay close to the arteries and veins ; sometimes it com- 
pletely surrounded an artery or vein. This, together with 
some other experiments, proved that it 
was by the blood vessels and not by the 
lymphatics that absorption took place. 
In order to still further test the mat- 
ter, he had injected muriate of pilocar- 
pine into the ankle and into the supra- 
clavicular region. The physiological 
effects of the drug (diaphoresis, sali- 
vation, etc.) were produced in both 
cases in about the same time, varying in 
different subjects from one and a half to 
four minutes ; there was no appreciable 
difference. If the absorption had been 
by means of the lymphatics, the injec- 
tion in the supraclavicular region would 
have produced its effects much more 
rapidly than that injected into the ankle. 
In one of the slides the section had fortu- 
nately been in the line of the puncture 
of the needle, and showed that consider- 
able injury had been done to the tissues. 
I am firmly convinced that no physician 
should be held free from blame in case 
of accident where he has not had a liga- 
{Agnew.) ture or tape loosely encircling the arm 

a. Commencement of the a b ove t } ie point of puncture. At the 

Cephalic \ ein ; 6, Mam L r 

Trunk of the Cephalic nrs t intimation of danger this should be 

Vein ; c, Anterior Branch ° 

of Basilic vein; ^Poster- p U iied tight and kept so for several 

ior Branch of Basilic V ein; _ x 

e, Basilic Vein ; /, Median hours, being loosened gradually, thus 

\ ein ; g, Median Basilic . . ° ° J 

Vein; h, Median Cephalic permitting but a gradual entrance of the 

Vein ; i, Biceps Muscle ; /, ° ° 

Tourniquet. drug into the general circulation. With 



SUBCUTANEOUS INJECTION. 101 

tli is precaution it will be seldom necessary to treat such 
alarming symptoms as are here recorded. A tourniquet 
for this purpose is here shown. It consists of a strap or 
heavy tape, at one end of which is sewed a " patent buckle/' 
that will catch and hold at any point. In the absence of 
this or a skate strap with such a buckle, any cord or tape, 
so arranged as to be pulled tight at a moment's warning, 
may be used. The treatment of such condition when al- 
ready established, is summed up in one word — stimulation. 
Whiskey and ammonia hypodermically, cold affusion, elec- 
tricity, when there is a battery at hand, and hot bottles to 
the praecordia. 

In some instances tetanus has followed the use of rusty 
needles, in one case resulting in the death of the victim, 
an habitue.* 

At Southsea, recently, an inquest was held upon the 
body of Mrs. Frampton, wife of a lieutenant and adjutant 
in the Royal Marine Light Infantry. 

The husband of deceased deposed that his wife was twenty- 
five years old, and that in 187 1, previous to giving birth 
to a child, she suffered greatly from sickness. A surgeon, 
to alleviate this, used morphia by the hypodermic method, 
always injecting the solution himself. Some time since 
deceased assured him she had entirely given up the use of 
morphia. 

On the previous Thursday he found the deceased suf- 
fering from convulsions. She grew worse and died the 
following morning. Since her death several bottles had 
been found in her wardrobe, tied up in a parcel and se- 
creted, together with five or six small cases, each contain- 
ing a hypodermic syringe. 

" The Hypodermic Injection of Morphia ; its History, Advantages and Dan- 
gers." N. Y., 1880. 



102 THE OPIUM HABIT. 

Mr. Cruise, pharmaceutical chemist, said that at first he 
refused to serve the solution, but on reference to his junior 
assistant he was informed that Mrs. Frampton had been 
frequently supplied with the solution. In August, Sep- 
tember and October, he supplied nine bottles each month, 
the last being on the 30th ult. 

Dr. Norman described the state he found deceased in, 
and stated that when Mr. Norman and Dr. Jackson were 
called in they discovered on the upper part of both arms a 
large number of old scars, which they were informed were 
the result of hypodermic injections five years ago. There 
were no recent marks about the arms, but upon both thighs 
there were a large number of similar marks, and also seve- 
ral marks of recent punctures. Around some of these 
latter there was a redness of the skin in different stages, 
and one particularly had the appearance of having been 
made within twenty-four hours. He was of opinion that 
Mrs. Frampton died from tetanus, caused by the punctures 
made in the thighs for the purpose of injecting a solution of 
morphia. He had been shown three syringes, all of which 
were in a dirty condition, apparently not having been 
wiped dry after using. The steel needles were in a very 
rusty state, which would be likely to set up inflammation. 

The jury returned a verdict to the effect, " That the 
deceased died from tetanus, or lockjaw, caused by inflam- 
mation arising from punctures made by the deceased her- 
self, for the purpose of subcutaneous injection of a solution 
of morphia."* 

The newspaper report of the following case has been 
kindly sent me by F. W. Barkitt, l.r.c.p., etc., Dublin, 
Ireland. The extract is from the Irish Times newspaper, 
October 23d, 1870, giving an account of the coroner's 
inquest : — 

* Medipal Press and Circular, Nov. 29th, 1876. 



SUBCUTANEOUS INJECTION. 103 

The patient was a governess, single, aged 56, and ad- 
dicted to the morphine habit, using the drug hypoder- 
mically. 

" Dr. Austin Meldon deposed he was called to see the 
deceased on the morning of the 16th instant. He found 
her in the spasm of lockjaw. She was actually in the 
spasm when he entered the room, her body being bent 
forward. Witness was of opinion the disease commenced 
late on Sunday night. From examination and inquiry, 
witness had made up his mind that the disease was caused 
by a slight wound, inflicted by the needle of a subcuta- 
neous injection syringe. There were numbers of marks 
over her body, where she had been in the habit of making 
these injections. The slight wound to which he had re- 
ferred was made on the previous Friday. He found she 
had been in the habit of using these injections for years. 
That morning she told him she had used twelve grains of 
morphia in one injection, and showed him the papers 
which had contained the four powders. That was an 
enormous quantity, a quarter grain being a full dose. The 
immense quantity she used that morning showed she had 
been using it for years. She told him that she was in the 
habit of using, when affected with neuralgia, twenty grains 
in twenty-four hours. There was no case on record of so 
much being used.* 

Witness asked her why she had adopted that mode of 
taking morphia. She said, in order to avoid the tempta- 
tion of taking more of the drug. There was a case of 
poisoning from morphia in the same way in London, last 
year, but the quantity was considerably smaller — the dose 
taken being only one grain four times a day. After 

* In my chapter on " The Morphia Habit," I shall show that much larger 
amounts have been used, and for long periods. 



104 THE OPIUM HABIT. 

witness saw her, he continued the injections during her 
spasms, and they relieved her pain, but, of course, the 
doses he gave were very small, and as the suffering became 
less, so did the quantity in the injection he administered. 
He would account for the lockjaw which caused her death 
by the particular puncture in the skin, as a nerve might 
have been injured by the entrance of the needle. It was 
a very hazardous thing for an unprofessional person to 
use one of those needles. He knew of two cases of 
lockjaw caused by it. In one of these cases, the patient 
was very nearly poisoned, for he used when he had no 
pain a dose which had been ordered him by a medical 
man when he was in great pain. 

Witness made a careful post-mortem examination. He 
had never seen a lady of that age whose organs were in a 
more healthy condition. The reason she used it, I may 
say, was to relieve facial neuralgia, in the first instance, 
and the habit grew on her. I found the surface of the 
body punctured in innumerable places with the needle. 
She seemed as if she had been tattooed. 

i ' Coroner. Is there anything else you think it well to 
tell us ? Are you certain she died from traumatic tetanus ? 
' I am clearly of that opinion, both from the history and 
condition of the case.* 

"Coroner. There is one point which I would wish to 
have cleared up. Several medical men have mentioned 
to me that it is quite possible she might have obtained, 
either by mistake or otherwise, strychnia in place of mor- 
phia. You are satisfied that is not the case ? i I am per- 
fectly satisfied. I should say that the symptoms of tetanus 
and strychnine poisoning are the same while the spasms 
are on. After the spasms pass away, the patient becomes 



SUBCUTANEOUS INJECTION. 105 

quite well in strychnine poisoning, but the muscles remain 
contracted in lockjaw.' " 

I have written Dr. Meldon, asking for histories of the 
two cases of tetanus referred to, but as yet have not had a 
reply. The British Medical J ournal, in commenting on 
this case, says that it has no knowledge of the case referred 
to by Dr. Meldon as occurring in London, but refers to 
three cases of death from traumatic tetanus after the hypo- 
dermic injection of the sulphate of quinine {Lancet, July 6, 
1867), and a case of tetanus after the use of morphia, due, 
probably, to the use of rusty needles {Lancet, December, 
1876, p. 873). 



10G THE OPIUM HABIT. 

CHAPTER VI. 

THE TREATMENT OF THE OPIUM AND MORPHIA HABITS. 

So many of our fellow-men have been, in the past, are 
now, and will be, bound hand and foot in this terrible 
bondage, from which they seem utterly incapable of re- 
leasing themselves ; so many illustrious men have offered 
themselves as living sacrifices to this false deity ; so many 
lives have been ruined, homes desolated, hopes destroyed, 
ambitions smothered by it ; so many of those dear to us 
have fallen beneath the shadow of this sickening evil ; so 
rapidly is the habit spreading, that the question of its 
treatment and cure has become one of momentous import- 
ance. 

Reading the histories of those cases where a cure was 
effected some years ago, one's mind is divided between 
admiration of the great heroism displayed by the unfortu- 
nates, and pity for the agony which they were allowed to 
endure. 

Great advances have been made in the treatment of this 
affection in the last few years, and to-day, although science 
is unable to substitute for the accursed drug one that can 
fully take its place, still she can lend a helping hand, 
whereby the ascent is made easier and more rapid. The 
suffering incident to the breaking of the habit can, in a 
great measure, be relieved. 

The method strongly advocated and practiced by Leven- 
stein, of Germany, I consider barbarous in the extreme, 
and dangerous. The following cases, a type of all, select- 
ed from those published in his book,* well illustrate this : — 

* " Morbid Craving for Morphia." London, 1880. 



TREATMENT. 107 

Mr. von X., sent to the Institution by Professor West- 
phal, had caught cold while on a journey, which brought 
on rheumatic pains. To relieve him injections of morphia 
have been administered since 1872, at first by the medical 
attendant, and afterward by the patient' himself, and in 
increased quantities, the largest daily dose having amounted 
to sixteen grains. The symptoms showing themselves in 
consequence of this use were loss of appetite and sleep, 
excited condition, emaciation, tremor of the hands. 

On October 9, 1875, patient came into the Institution; 
he had injected morphia for the last time on the morning 
of the same day. At 10 p.m. patient went to bed and at 
once fell asleep. At 3.30 a.m. he was sick, felt very weak 
and prostrate, suffered from twitching in the lower extrem- 
ities and diarrhoea. 

October 10. In the morning patient had five relaxed 
motions. Frequent vomiting during the whole of the day. 
Excitement and intense craving for morphia increases 
hourly. In the afternoon he talks of suicide. 

October n. Patient has had no sleep during the night, 
but has been frequently sick. Severe vomiting continued 
until n a.m., but stopped entirely during the rest of the 
day. Patient complains of languid pains in the legs, severe 
pain in the stomach. 

October 12. At 1 o p. m. patient suddenly started up, and in 
a frightened manner asked, several times, "Was not the 
doctor in the room just now?" only the nurse having been 
present. Until 12 p.m. he laid in bed quietly without 
speaking ; he afterward raised himself up and screamed 
out, in great excitement, "Who is that big fellow in the 
next room ? He is so tall that he cannot get through the 
door ! And now he is getting taller still. Now there are 
several of them \ they are ghosts ! ' ' His voice was 



108 THE OPIUM HABIT. 

trembling, his extremities in constant convulsive move- 
ments. He was quieted, but only with great difficulty. 
Again and again he raised himself and anxiously looked at 
the door. Temperature, 38.5 C. (101.3 F.). In the 
morning the patient addressed the superintendent, as he 
entered, as follows : " Ah, good morning, dear Emily. I 
am very glad you are coming ! ' ' While saying so 
he was lying down quietly. Now and then he raised 
his head slightly and looked at the wall for a time, 
as if observing something, and his lips were moving as if 
he was talking to somebody. In the course of the day he 
vomited considerably, several times. Patient feels very 
weak, the speech is unintelligible, the tremor has increased. 
He entered into a short conversation, and thinks himself 
better than yesterday. Although very tired he cannot get 
to sleep. Pulse was strong throughout the day. Auscul- 
tation and percussion of the lungs and heart showed a 
normal condition. The bladder was empty and no urine 
was passed until 5 p.m. Several relaxed motions. 

October 13. Toward midnight patient suddenly raised 
himself up, looked around, stretched his hands, as if fright- 
ened, and called out in a trembling voice, " What do you 
want ? There is the — the ghost ! ' ' The voice next morn- 
ing was hoarse, hesitating, unintelligible, devoid of sound. 
The features looked worn. During the whole of the day 
there was diarrhoea and vomiting. An injection of food 
into the bowels was given (after Leube). 

October 14. Patient has slept for only a quarter of an 
hour in the night. The other part of the time he was 
dozing; vomited four times, and had four relaxed motions. 
At 5 a.m. he called out to those watching him during the 
night, u Come along, come along, quick, quick!" He 
gradually lost consciousness, did not move upon being 



TREATMENT. 109 

called. Pulse 40, very small, hardly to be felt ; respira- 
tion gasping, slow. Hippocratic face. Injected one- 
fourth of a grain of morphia. Pulse and respiration soon 
became regular, and he regained his consciousness. There 
was no vomiting during the day. The voice is still gone, 
the features worn. Toward the evening the patient had an 
injection of food (Leube) of sixteen and a half ounces. 
Great prostration. Skin moist and hot. 

October 15. Patient had no sleep, but lay quietly in 
bed until about 2 a.m., when there was vomiting, oppres- 
sion, moaning, clonic contractions of the muscles of the 
face and extremities. Pulse strong. 

October 16. He had three relaxed motions, vomiting 
and bleeding of the nose during the night. During day- 
time patient felt well. 

October 17. Patient has had no sleep during the night, 
but was quiet ; vomiting and diarrhoea. In the day feeling 
of great weakness. Appetite good. 

October 18. No sleep, patient feels thoroughly knocked 
up. In the afternoon he slept for a short time. 

From this time the patient's condition was satisfactory/ 
He slept at first for three hours, afterward for five hours, 
at last during the whole of the night ; the appetite increased 
considerably, the disposition was changed. He left the 
Institution on November 21st. 

Urine. — The specific gravity of the urine vacillated be- 
tween 1. 01 9 and 1.029. A precipitation with alkaline 
solution of sulphate of copper was noticeable only occa- 
sionally. 

The patient, whom I saw six months after his discharge, 
has had no 'relapse. 

Mrs. Jane G., a patient of Dr. B. Frankel, of Berlin, 
35 years old, eleven years ago, after having been suffering 



110 THE OPIUM HABIT. 

with typhoid fever, was afflicted with an abdominal com- 
plaint which caused so much pain that the family doctor 
had to administer an injection of morphia daily. Ten 
years ago patient married, and has given birth to two 
children one five years, the other eight years old now. 
The confinements were protracted ; both children died 
soon after their birth. During both pregnancies the 
use of morphia was discontinued by the doctor, the same 
taking place during several occasional journeys to bathing- 
places made by the patient because of her complaint. For 
five years she has injected morphia herself, the largest dose 
pro die having been eight grains. 

While using the drug, a febris intermittens tertiana 
showed itself, two years ago, lasting, with an interruption 
of four weeks, until November, 1876. Regularly at 4.30 
p.m. she had shiverings, followed by burning heat, and 
ending in perspiration. The repeated use of quinine, even 
a change of air and a sojourn in the country, were unable 
to suppress the fever. Dr. B. Frankel, who had only for 
three months attended Mrs. G., and whom she had never 
told of her custom of using morphia regularly, made the 
diagnosis of morbid craving for morphia only through con- 
sidering the intermittent fever. Apart from the latter, the 
use of the drug had brought on the following symptoms : 
sleeplessness, headache, principally in the region of the 
right occipital nerve, parched mouth, loss of appetite, nau- 
sea, sickness, constipation, feeling of oppression, mental 
anxiety, palpitations of the heart. Patient, after having 
hardly fallen asleep, wakes up with dyspnoea, which in- 
creases to actual fits of choking ; swimming before the eyes 
and muscular quivering. 

Patient is admitted into the Maison de Sante, and the 
use of the morphia is stopped forthwith. 



TREATMENT. Ill 

October 16. Hardly any sleep during the night; in the 
morning patient is in a happy temper, makes no complaints. 
Temperature and pulse normal. In the course of the fore- 
noon there was much perspiration, and patient complained 
of headache and nausea. Pupils unequal, the left smaller 
than the right. Pressure on the stomach, shivering, yawn- 
ing ; in the afternoon, there is restlessness, stomach-ache, 
epigastric pain, oppressiveness, much perspiration, shiver- 
ing. Poultices were applied to the abdomen. Up to the 
evening she had altogether vomited twelve times and had 
one relaxed motion. Pupils unequal, the left wider than 
the right. The excitement, in consequence of the pain in 
the stomach, increases hourly. Patient moves about in 
bed and moans aloud. Frequent spasmodic yawning. At 
9 p.m., a bath with cold douche of a quarter of an hour's 
duration is given, after which she became quieter for a 
short time. 

October 1 7. Patient has been sick thirteen times during 
the night ; no sleep ; the pains in the abdomen were very 
severe, having the character of labor pains. Face pale, 
pulse 64, full, regular. Frequent yawning, burning in the 
throat, and abdominal pains continue during the whole cf 
the day. Patient looks worn out, is now and then in a 
half -dozing condition. Left pupil wider than the right. 
Great prostration, great thirst. In the course of the day 
vomited nine times, two relaxed motions. 

October 18. No sleep during the night, restless ; com- 
plains of tearing pains in the legs, and excessive pain in 
the stomach ; pulse and respiration normal ; vomited four 
times, one relaxed motion, frequent sneezing during the 
day ; she is very sensible to every kind of noise. Fre- 
quent retching; severe vomiting ten times. Left pupil 
wider than the right. Patient feels cold. In the afternoon 



112 THE OPIUM HABIT. 

at 5 o'clock patient lisps, becomes of a pale, death-like 
color, is very much oppressed, and loses consciousness ; 
sinks back on to the pillows with closed eyes. Pulse 42, 
small, irregular. A quarter of a grain of morphia was at 
once given, and repeated after twenty minutes' time. 
Right pupil wider than the left. After a quarter of an hour 
patient wakes up, says that she^had never felt so well be- 
fore; takes milk with relish without bringing it up again. 
Pulse 60, strong and powerful. This favorable condition 
lasts till 9 p.m., when she again has nausea from time to 
time. At 10 o'clock a bath, with a cold douche, is given. 
October 19. Patient has slept only from 10.30 p.m. to 
1.30 a.m. At this time retching again occurs, vomiting, 
prostration, pains in the epigastric region ; hallucinations, 
illusions set in, followed by collapse accompanied by the 
symptoms already mentioned, and necessitating the imme- 
diate injection of half a grain of morphia at 2.20 a.m., 
followed by a weaker injection of a quarter of a grain of 
morphia at 4.15 a.m. Afterwards patient again felt quite 
well. During the forenoon her condition has been good 
only at times, the principal complaints being great pros- 
tration, impossibility to sleep, pains in the stomach, great 
thirst. Left pupil wider than the right. About 10 a.m. 
the sickness increased to such an extent that an injection 
of one-fifth of a grain of morphia had to be administered. 
Feeling well after it, patient partook of a pint of milk and 
soup. In the afternoon she had some cocoa, which she 
has not brought up. Towards the evening she felt op- 
pressed, which, however, subsided after a warm bath, with 
cold douche. At 9.25 p.m. another injection of a quarter 
of a grain of morphia had to be given, on account of symp- 
toms of a collapse showing themselves. Only three-quar- 
ters of an hour afterwards the good effect was visible. 



TREATMENT. 113 

October 20. Patient has slept altogether for five hours 
during the night, with many interruptions. During the 
intervals, besides being restless, there was prostration, 
craving for morphia, nausea, and frequent vomiting, and 
pains in the stomach. In the morning sneezing and yawn- 
ing. During the daytime the condition was comparative- 
ly good. Left pupil wider than the right \ towards the eve?i- 
ing the contrary taking place. At 8.30 p.m. patient had 
a bath at 31 R. (87. 8° F.) of half an hour's duration, with 
cold douche. 

October 21. Restless during the whole of the night, 
craving for morphia and increased reflex action. During 
the daytime the condition of the patient is satisfactory, 
excepting some yawning, sneezing, and slight prostration. 

October 22. No sleep during the night, paroxysms of 
sneezing and yawning. 

October 23. Patient slept for three hours with interrup- 
tions. Towards the morning severe sneezing. Appetite 
good. She had a bath, with cold douche, morning and 
night. 

October 24. Patient was very restless in the night, 
moved about in the bed, and in the morning was much 
exasperated on account of the bad night. At 9 p.m. 40 
grains of chloral were given in gruel, but were immedi- 
ately brought up again. 

October 26. Patient slept for two hours with interrup- 
tions. During the remainder of the night she felt op- 
pressed and had palpitations of the heart. Sneezing the 
same as yesterday. 

October 28. Very restless during the night. Patient 
had only about one hour's sleep towards the morning, and 
then felt pains in the lower part of the abdomen. 

October 29. Has had hardly any sleep during the 



114 THE OPIUM HABIT. 

night. Mental condition nevertheless good \ appetite the 
same. 

October 31. During the past nights she slept, on the 
average, for three hours. Meals are taken regularly. 
Thirty grains of chloral were given in capsules. Patient 
in the daytime complains of labor-like pains in the lower 
abdominal region. 

November 1 . Patient slept for several hours after having 
taken 30 grains of chloral. The pains in the hypogastric 
region are still apparent now and then ; some reddish 
watery spots show on the linen. 

November 2. The pains have increased in the morn- 
ing ; the whole abdominal region is sensitive to the touch. 
Poultices were applied. In the middle of the day the men- 
strual discharge shows itself. 

November 3. The pains have abated. Patient has 
slept for four hours. 

November 4. Menstrual discharge still continues. 
While it is said formerly to have lasted only for a few 
hours, it has now lasted for forty-eight hours. Toward 
midday the patient left her bed and remained on the couch 
for several hours. 

November 5. Slept from 11 p.m. till 2.30 a.m. Patient 
felt oppressed in the night \ there was difficult breathing, 
and she could not remain in bed. 

Patient leaves the Institution on November 15 th, all 
bodily functions having become regular. She has up to the 
present time had no relapse. 

In favor of this plan of treatment Levenstein urges the 
following : " Confidence in the medical adviser is strength- 
ened in consequence of the short duration of the severe 
symptoms, and the improvement already experienced after 
a few days ; the patients take courage, look forward to 



TREATMENT. 115 

their complete recovery, and submit with patience and 
resignation to the few days of suffering. " And again : 
" The human organization, as we know from our surgery, 
midwifery, etc, will, in general, submit more easily to 
sudden and energetic treatment, even when acting power- 
fully, than to a milder influence. The gradual deprivation 
requiring a long time, excites the physical and moral 
powers to a greater extent, because every dose, smaller 
than the previous days' quantity, will produce new symp- 
toms of reaction. The constant mental anxiety in which 
these patients live, while expecting a smaller dose on the 
following day, makes them fretful and irritable ; their 
intention of submitting till the end of the cure, and their 
energy, begin to decline, and they try to evade the treat- 
ment. They set up intrigues against the officials and 
nurses ; they simulate morbid appearances, in order to 
excite the pity of their relations and friends ; they lose 
confidence in themselves and in their doctor, whose full 
and absolute authority is indispensable for the successful 
treatment of abstinence. ' ' 

This is certainly true of those cases where the treatment 
is by very gradual reduction, not at all so of those where 
it lasts but from four to seven days ; ten at the most. The 
latter plan combines all the advantages of Levenstein's 
method, and escapes the danger and misery of his, and that 
of the long protracted course. 

In many instances persons addicted to this habit gradu- 
ally reduce the quantity they have been using to a certain 
point, beyond which they seem unable to go. Thus, a 
physician who came under my care reduced his dose from 
three grains to one-twelfth of a grain in the twenty-four 
hours, and maintained it at this point for a long time. 
Finally, however, he returned to the use of the full amount. 



116 THE OPIUM HABIT. 

He employed the subcutaneous method. The majority of 
patients express their willingness to be rid of the habit, and 
do endeavor, up to a certain point, to assist themselves, 
but at this period will power, naturally weakened, gives 
way, and good resolves are thrown to the wind. It is 
at this time that every facility for full control of the pa- 
tient is necessary, for without it the sufferer will invariably 
stop treatment, claiming that the suffering is beyond his 
strength, bemoan his sad fate and return to the old habit 
with renewed force, exclaiming, with Coleridge's son — 

" O woeful impotence of weak resolve." 

The treatment of these cases at the homes of the habitues 
is rarely successful. Some ruse, some strategy, some decep- 
tion is sure to be practiced, either by the patient, the 
friends, the relatives or the nurse. Very often the relatives, 
not understanding the meaning of certain symptoms, 
distressed beyond measure by the pitiful pleadings of the 
sufferer, will interpose and at once put an end to treatment, 
thus unwittingly and with well meaning doing the patient 
an injury of the gravest kind. For, the treatment, persisted 
in almost to the point of cure and then abandoned, so 
thoroughly disheartens the person that it takes a long time 
for him to make up his mind to try it again. 

Those who are the most likely to behave in a manner such 
as to cause their friends to interfere, from fear of death or 
insanity resulting, are hysterical females. Absolute com- 
mittal to a public or private institution, where the nurses 
can be absolutely relied upon, and where obedience to the 
physician's orders are rigidly enforced, is the only rational 
plan for treating these cases. Then, too, conveniences for 
baths of different kinds and temperatures, and varied elec- 
trical appliances, not found in patient's houses, are neces- 
sary; more necessary than drugs. 



TREATMENT. 117 

It is best for the patient, if an adult, or the parents of 
the patient, if he is a minor, to sign a paper, submitting 
him fully to the entire control of the physician for ten days. 
On leaving home his trunk and clothing should be thor- 
oughly searched, and any form of opium or morphine 
should be removed. On entering the institution in ques- 
tion, the person is allowed from twenty-four to forty-eight 
hours' rest, to recover from the effects of the journey, to" 
become acquainted with his surroundings, and to allow the 
physician in charge to judge fully the amount of morphine 
taken, and the condition of the different organs. The 
urine should be carefully analyzed and the result saved for 
future reference. The windows in the rooms are to be 
firmly secured, and no extra furniture, sharp instruments, 
or projections from which hanging could be possible, are to 
be allowed. Low, iron bedsteads are to be preferred, and 
the room heated by furnace or steam pipes, well protected. 

On commencing the treatment, the patient is required 
to give up all money or valuables he may have about him, 
for which he is given a receipt. He is then undressed by 
a nurse, wrapped in a blanket, and taken to the bath-room, 
where he is given a bath. While this is being done, an- 
other nurse, under the supervision of the physician, searches 
everything the patient has brought with him, includ- 
ing the clothes just removed, and takes away any morphine 
or opium that may have been secreted, as, also, scissors, 
knife, needles, etc. The search must be very thorough, as 
I have known patients to sew packets of morphine into the 
lining and waistbands of their clothing. The patient is 
then brought back to his room, the nurse fully instructed, 
and the treatment by rapid reduction commenced. 

The physician himself administers the drug, whether by 
the mouth or by the skin. I usually reduce the quantity 



118 THE OPIUM HABIT. 

used in twenty-four hours one-third, sometimes one-half, 
the first day. The following case will illustrate the plan 
pursued : — 

Miss B. (sent to me by Drs. Claggett and Walls, of 
Baltimore), single, aged twenty-seven, born in Virginia. 
Tall, thin, emaciated. Weight about ninety-eight pounds. 
Complexion reddish. Dark-brown hair, grayish-blue eyes. 
Height five feet seven and one-half inches. Extremely 
nervous temperament. Pupils irregular and contracted. 
Entered my house for treatment October 16, 1880. Had 
been taking morphia subcutaneously for eighteen months. 
It was first given her by a physician, to relieve the intense 
pain of an attack of pelvic cellulitis. At the end of the 
treatment, being still a sufferer, she procured a syringe, and 
continued the injections herself, gradually increasing the 
dose until the daily amount reached six grains. Some- 
times it would be less than this. She was accustomed to 
take three injections in the twenty-four hours ; one in the 
early morning, one about midday, and one late in the 
afternoon. She ceased to menstruate three months after 
she commenced to use the drug, and had not menstruated 
up to the time of admission. No history of alcoholic 
excesses in ancestors. Has one sister who is extremely 
nervous, and a brother just recovering from paralysis of 
one side of the face. 

Her face is dotted with pustules, as also the chest. Body 
and limbs marked by cicatrices of old and recent punctures. 
Appetite fair, bowels constipated. Somewhat lethargic 
and stupid in mind, but, withal, very nervous. Is despond- 
ent, and cries easily, but is very anxious to abandon the 
habit. There is some vaginismus and spasm of the sphinc- 
ter of the bladder. 

October 15, 1880. Seen by Dr. T. Addis Emmet, who 



TREATMENT. 119 

pronounced her to be free from all uterine and ovarian 
disease, beyond the remains of an old pelvic cellulitis, by 
which the uterus was drawn somewhat to one side. He 
recommended the injection of large quantities of hot 
water. 

October 16. Was given four grains of morphia, subcu- 
taneously, in two doses, one at 7 a.m., the other at 3 p.m. 
Is feeling very much depressed and homesick. 

October 17. Passed a fair night. Very nervous in the 
morning. Given one hundred grains of the bromide of 
potassium. Fluid extract of coca (Parke, Davis & Co.), in 
half-ounce doses, at 9 and n a.m., 2, 4 and 9 p.m. ; also 
one-half grain pills of cannabis indica, at 8 and 10 a.m., 
3, 5, 7 and 10 p.m. Given two grains of morphia at 7 
a.m., and one grain at 2 p.m. More quiet \ using beef tea 
(the juice of steak squeezed into boiling water and sea- 
soned), sherry and bottled beer. Some pain over left 
ovary. Ice cream and milk for supper. 8 p.m., Pulse 100. 
Less nervous ■ more talkative and pleasant ; expressed a 
desire for oysters. Pain over left ovarian region some- 
what relieved by poultices. Bowels have not moved for 
two days. 

Urine. — Specific gravity 1.018; reaction acid; color 
pale amber ; odor normal ; sediment slight; microscopi- 
cally nothing ; chemically nothing save an excess of phos- 
phates. 

October 18. Passed a goodnight. Pupils of medium 
size and regular. Craves food. Given two -thirds of a 
grain of morphia, at 7 a.m. Obliged to draw her water ; 
this had been her habit for a long time. Poultices to left 
ovarian region. Bromide and other medicines continued 
as before. Two-thirds of a grain of morphia at 3 p.m. 



120 THE OPIUM HABIT. 

Rather nervous and restless, but bright. Appetite good. 

Given — 

R. Mass. hydrarg., 

Ext. colocynth co., aa . • gr.iij. 

At bedtime. 

One bottle of beer and some sherry wine. Two-thirds of 
a grain of morphia at bedtime. Left pupil larger than the 
right ; both somewhat dilated. Is suffering slightly from 
bromism. 

During the day she has taken the following mixture every 
three hours, while awake : — 

U . Strychniae sulphat., . . . gr.ss 

Tinct. belladonnae, 

Tinct. capsicum, aa • giij M. 

Sig. — Take ten drops every three hours, increasing three drops 
each day. 

October 19. Slept well all night. Two-thirds of a 
grain of morphia at 5.30 a.m. Bright. Appetite good. 
Dressed herself and came down stairs. Half a grain of 
morphia at 3 p.m. Medicines continued as usual, with the 
exception of the bromide, which was given in the form of 
an elixir (ten grains to the drachm), one drachm after 
each hemp pill. Pupils regular. Pulse good. 6 p.m., 
had a severe hysterical convulsion, brought on by talking 
and thinking about home. Given two -thirds of a grain of 
morphia. Some headache. Bowels have not moved yet. 
Given seidlitz powder. 

October 20. Rather nervous during the night. Tossed 
from side to side of bed. Bowels moved naturally about 
2 a.m. Two-thirds of a grain of morphia at 6 a.m. Pupils 
contracted and even. Slight headache. Restless. One- 
third of a grain of morphia at 3 and 9 p.m. Much head- 
ache. 

October 21. Bowels moved naturally during the night. 



TREATMENT. 121 

One-third of a grain of morphia at 6 a.m ; one-third of a 
grain at 2.30 p.m., and one-sixth of a grain at 6 p.m. 
Appetite excellent. Took some exercise in the yard. 
Hysterical attack at 5 p.m., after reading a letter from 
home. Given twelve grains asafcetida. Bromide erup- 
tion on chest and back. Urine slightly albuminous and 
containing a trace of sugar. 

The spasm consisted of moaning, with greatly labored 
breathing, the moan being made at each full expiration. 
There was trembling of the hands and twitching of the 
muscles, accompanied by a feeling of suffocation. Pulse 
small and frequent. At 6.30 p.m. was sufficiently recov- 
ered to eat a hearty supper. During the evening she felt 
well. One-sixth of a grain of morphia at 9 p.m. Ordered 
half an ounce of tincture of hyoscyamus at bedtime. 

October 22. Restless all night. Hyoscyamus did not 
produce more than two hours' sleep. One-sixth of a grain 
of morphia at 6 a.m. Very nervous and restless all morn- 
ing. One-sixth of a grain of morphia at 3 P.M. Complains 
of pain in body, limbs and side. Given a very hot sitz-* 
bath, followed by belladonna plaster to ovarian region. 
One-twelfth of a grain of morphia at 6 p.m. Less nervous 
at 7 p.m. Vomited once. One-sixth of a grain of mor- 
phia at 9 p.m. Still restless. All medicines continued. 
Pupils dilated and irregular ; right larger than the left. 

October 23. Passed a sleepless night. Very nervous 
in the morning. One-sixth of a grain of morphia at 6 a.m. 
Distressing nausea and vomiting. Given ice and wine. 
In the afternoon there were some * symptoms of collapse. 
One-twelfth of a grain of morphia at 1 p.m., one-half grain 
at 4 p.m., one-twelfth grain at 5 p.m., and one-sixth grain 
at 9.30 p.m. Towards night the nausea ceased. Com- 
plains of severe pains in limbs and back. Is thoroughly 



122 THE OPIUM HABIT. 

rubbed with whiskey and water. Pupils contracted. 4 p.m. 
slight symptoms of collapse. Gave stimulants. In place 
of belladonna, strychnia and capsicum mixture, ordered 
the following: — 

R . Strychnia sulph., .... gr.ss. 

Tinct. belladonnse, . . . £ij 

Tinct. lobeliae, . . . . gj 

Tinct. stramonii, . . . gj 

Tinct. capsicum, . . . . ^ij. M. 

Sig. — Take twenty drops every three hours, increasing three drops 
daily. 

Continued the other medicines in the same way as be- 
fore. Urine passing freely. Albumen one-twentieth of 
the bulk. No sugar. Hysterical attack at 9 p.m. 

October 24. Slept well all. night. Given four ounces 
of milk and lime water every two hours ; also some milk 
punch. Severe hysterical tetanoid seizure on rising from 
commode. Lasted over an hour. Great difficulty in over- 
coming spasm of respiratory muscles. Expiration loud 
and forcible. Hands clenched. Fingers and toes forcibly 
flexed. Clonic spasm of muscles of face and jaw. Face 
purple, veins distended, pulse at wrist hardly perceptible. 
She was put fully under the influence of ether, with good 
result. Complained of headache, nausea and soreness of 
muscles, after the effect of the ether wore off. Says that 
when she stood, a pain darted into the left ovary, and 
threw her into the spasm. Medicines continued. Gave 
hot hip bath, followed by cold douche, and the interrupt- 
ed current along spine and over ovary. Also massage, 
which greatly relieved • pains in limbs and soreness of 
muscles. 

12 m. Feeling bright and cheerful. Took some bottled 
beer. Bowels have not moved for two days. Poultice 
over abdomen. One-twelfth of a grain of morphia at 3 



TREATMENT. 1 23 

p.m., also one-twelfth grain at 8 p.m. This was the last 
dose of morphia. At 9 p.m. another hysterical spasm. 
Again etherized. Soon after this the bowels moved. 

12 midnight. Left pupil larger than the right. Slept 
from 2 to 5 a.m. 

October 25. Very nervous and restless. Complains. of 
constriction of chest by an imaginary band. Dyspnoea. 
At 6 a.m. another spasm on rising from commode. Again 
resorted to ether, after three hundred and thirty grains of 
bromide of potassium in an hour and a half's time had failed 
to relieve. A few whiffs of ether were sufficient. Some nausea 
from the ether. 9 a.m., symptoms of collapse that yielded 
readily to brandy. In a quiet state all day. Stimulants 
and liquid nourishment every hour. Some vomiting, 
sneezing and hiccough. Diarrhoea during the day. Face 
purplish red. Respiration 36 ; pulse 120. Stupid but not 
sleeping. 

6 p.m. Improving. Recognizes faces; talks ration- 
ally, but speech thick. Takes food well and seems to 
enjoy it. Double Vision. 9 p.m., restless. Wants to get 
up and walk about the room. Given a subcutaneous 
injection of water. Slept for two hours. Medicines 
continued. 

October 26. Yawning, gaping and sneezing. Com- 
plains of pain in limbs, also of vesical and rectal tenesmus. 
An examination reveals a small hemorrhoid. Given a 
suppository containing half a grain of extract of bella- 
donna, which seemed to afford some relief. Pulse stronger. 
Dyspnoea less marked. Given a hypodermic injection of 
water at 8 a.m., 3 and 9 p.m., much to her relief. Doubts 
as to whether there was morphine in the solution used, were 
dissipated by letting her touch her tongue to the needle, 
which had been previously dipped in tincture of nux 



124 THE OPIUM HABIT. 

vomica. Complexion clearer ; eyes bright ; speech not so 
thick. Strychnia mixture stopped. 

8. p.m. Great rectal tenesmus, with small, offensive 
stool. Given one grain of extract of belladonna, by sup- 
pository, and a capsule containing — 

R . Mass hydrargyri, 

Ext. colocynth co., aa • • • gr.iv 

The mouth tasting badly, she was given the following as 
a wash: — 

U . Sodae hyposulphite, . . . g ss 

Tinct. kino, 

Tinct. myrrhse, aa . • 3J 

01. gaultheriae, gtt.xyj 

Aq. rosae, . . . .ad § iij. M. 

Sig. — Teaspoonful in half a glass of water. 

Pains in limbs and body still severe. Much relieved by 
a hot bath, followed by the cold douche. Hemp pills 
stopped. Stimulants and liquid food continued. 

State of partial collapse at 5 p.m. Relieved by the free 
use of stimulants. 

October 28. Slept well. From this time she improved 
rapidly. She was put upon cod-liver oil, cream, milk, 
generous diet and the following tonic : — 

R . Strychnine sulph., . . . . gr.^ 
Tinct. cinchona co., . . . g ij 

Three times daily. 

In nine weeks' time her weight increased from about 
100 to 146 pounds. 

The bromide eruption, which was severe, was treated 
with a wash of sodse salicylate, ten grains to the ounce. 

November 11. Some puffiness of abdomen and pain in 
left ovarian region. Given aloes, iron and myrrh, until 
bowels were moved freely. 

November 17. Menstrual flow established. Passed 



TREATMENT. 125 

through period with but little pain. Some leucorrhcea 
followed. Partly relieved by injections of infusion of 
white oak bark. 

December n. Again unwell. Less pain. 

December 23. Discharged well. Absolutely no craving 
for morphia. 

In this case the hysterical element was decided, and 
somewhat modified the treatment. 

The symptoms that follow the sudden deprivation of 
morphia are so vividly and well described by Levenstein, 
who has treated many cases in this way, that I cannot 
refrain from giving his own words : — 

"Although persons who suffer from morbid craving for 
morphia show different symptoms, some of them beginning 
to feel the effects of the poison after using it for several 
months, while others enjoy comparatively good health for 
years together, there is no difference between them as 
regards the consequences upon the partial or entire with- 
drawal of the narcotic drug. 

"In this respect they are all equal. None of them have 
the power of satisfying their passions unpunished. 

" Only a few hours have passed since using the last injec- 
tion of morphia, and already the feeling of comfort brought 
on by the action of the drug is passing off. They are 
overcome by a feeling of uneasiness and restlessness ; the 
feeling of self-consciousness and self-possession is gone, 
and is replaced by extreme despondency ; a slight cough 
gradually brings on dyspnoea, which is increased by want of 
sleep and by hallucinations. 

" The vaso-motoric system shows its weakness by abund- 
ant perspiration, by the dark color of the face, which 
replaces the pale condition apparent during the first few 
days. 



126 THE OPIUM HABIT. 

" Flow of blood to the head and palpitation of the heart, 
with a hard pulse, soon show themselves. The latter symp- 
tom often disappears suddenly, and is replaced by a slow, 
irregular, thread-like pulse, which is the sign of the begin- 
ning of a severe collapse. 

" The reflex irritability increases, the patients begin to 
sneeze and to have paroxysms of yawning ; they start if 
any one approaches them; touching their skin causes 
crampy movements or convulsions ; the trembling of the 
hands, if not already evident, now becomes distinctly per- 
ceptible. The power of speech is disordered ; lisping and 
stammering take place. Diplopia, and disorders of the 
power of accommodation, frequently accompanied by in- 
creased secretion of the lachrymal glands, show them- 
selves. The patients are overcome by a feeling of weak- 
ness and total want of energy, and are thus compelled to 
lay in bed. 

6 i Neuralgic affections of various parts of the body, pain 
in the front and back of the head, cardialgia, abnormal 
sensations in the legs, associated with salivation, coryza, 
nausea, vomiting and diarrhoea, tend to bring them into a 
desperate condition. 

i ' Some persons will bear up with fortitute under all these 
trials ; they will quietly remain in bed, and will endure 
the unavoidable suffering, hardly uttering a complaint. Of 
the others, although the great minority of them sleep and 
doze during this trying time, some can find rest nowhere ; 
they jump out of bed, run about the room in a state of fear, 
crying and shrieking. Gradually they become calmer, 
although occasionally their excitement increases. A state 
of frenzy, brought on by hallucinations and illusions of all 
the sensitive organs, at last causes a morbid condition, to 
which I have given the name of delirium tremens, resulting 



TREATMENT. 127 

from morbid craving for morphia, it being similar to that 
caused by alcohol. Some of the patients, however, will 
be found walking about in deep despair, hoping to find an 
opportunity of freeing themselves forever from their 
wretched condition." 

The patient whom I treated by the sudden deprivation 
of the drug was a married lady, aged forty-five, stout and 
flabby. She had been using morphia by the mouth for 
nearly sixteen years, in the last year taking from seven to 
ten grains daily. I saw her one afternoon and commenced 
treatment the next morning. The drug was taken away at 
once. That day she began to complain of salivation, dysp- 
noea, intense grinding pains in the calves of the legs, head- 
ache, pain about the heart and a strong desire for morphia. 
The first night she did not sleep at all. Was feverish and 
restless, tossing from side to side of the bed, moaning, 
occasionally crying out. Toward morning she became 
delirious, ran about the room, screamed, attacked the 
nurse, attempted to jump out of the window and battered 
at the door. By 8 a.m. she had sunk into a stupor, from 
which she was occasionally roused by fits of sneezing. A 
hard, dry, hacking cough supplemented the dyspnoea. 
Nausea was intense and vomiting frequent. She, on the 
third day, knew none of those about her, saw imaginary 
men and animals, wept, laughed, moaned and muttered 
incoherently. Sordes formed upon teeth and lips ; the 
faeces and urine were passed in the bed. In this state she 
remained for six weeks, in spite of every effort to arouse 
her. All day in a typhoid condition ; at night staggering 
about the room, screaming, crying and attacking the nurse. 
In the seventh week she began to recognize faces, although 
her hallucinations and deluSlbns continued. She very 
slowly regained strength. Pains persisted in the limbs. 



128 THE OPIUM HABIT. 

There was trembling of the hands and tongue, inability to 
read, and she would cry at the most trivial thing. Her 
nights were filled with terrible sights and dreams, the 
memory of which lasted her the whole of the following 
day. Several times there was severe collapse, necessitating 
the free use of stimulants and an occasional small dose of 
opium. During all this time tonics, concentrated food, 
baths and electricity were given. It was fully four months 
before her mind regained its balance. She was seen once, 
in consultation, by Dr. G. H. Wynkoop, of this city. 

That was my first case, and I shall never try the experi- 
ment again. I know of several instances where physicians 
have tried this plan and abandoned it. 

Her urine contained both sugar and albumen in large 
amount. This afterward wholly disappeared. 

Here is further testimony as to the efficacy of the treat- 
ment by sudden deprivation : — 

"Dr. Osgood {Quart. Jour. Inebriety, June, 1879,) nas ? 
in a hospital, during the past two years, treated 800 cases 
of opium inebriety. His plan, in general, is: (1) The 
absolute and total discontinuance of the use of opium from 
the beginning of treatment. (2) A trusty attendant to be 
with the patient day and night for the first three days. (3) 
Chloral hydrate for the first three nights, if required. (4) 
Good food, milk, raw eggs, brandy (in some cases), 
chicken broth. (The above to be taken in small quan- 
tities.) (5) In diarrhoea give two-drachm doses of a mix- 
ture of equal parts of tincture of catechu and tincture of 
ginger. (6) Vomiting will frequently yield to bismuth in 
fifteen-grain doses; and in some cases a single dose of 
calomel has acted like a charm. Ice is of advantage in 
some cases. (7) Through<ftt the entire treatment it should 
be remembered that the patient is below par, and requires 



TREATMENT. 129 

tonics. Quinine and tincture of iron have a prominent 
place in our list. (8) The patient should expect to suffer 
more or less for the first three days, and should make him- 
self a prisoner for that time. By the fourth day there is 
usually marked improvement. (9) Usually by the sixth 
day all desire for opium is gone. The patient then re- 
quires a change of air and surroundings, and tonics for a 
few weeks. Out of one hundred cases thus treated there 
was but one death and that from apoplexy." 

However well this plan may answer for the Germans and 
Chinese, it certainly is a dangerous and barbarous practice 
when applied to American and English people. 

The dangerous collapse that so often occurs in the carry- 
ing out of this method Levenstein combats by small, sub- 
cutaneous injections of morphine, stimulants, dropping 
ether on the skull, etc. 



130 THE OPIUM HABIT. 



CHAPTER VII. 

AGENTS EMPLOYED IN THE TREATMENT OF THE OPIUM 
AND MORPHINE HABITS. 

Limited space forbids my illustrating each modification 
of treatment with pertinent cases, and I content myself 
with discussing the various drugs and agents used, and the 
indications calling for their employment. In this way, too, 
the reader will become acquainted with the various symp- 
toms that arise in the course of rapid deprivation. 

BATHS. 

Baths of various kinds are the mainstay in the treat- 
ment of most cases of this kind. They are used for four 
purposes: (a) To allay excitement. (<£) To relieve pain. 
(V) To equalize the circulation, and (d) To procure sleep. 
They succeed when drugs fail. 

On the third or fourth day of treatment it is usual to 
have, especially in very nervous persons, considerable ex- 
citement, reflex nervous irritability, not so great, however, 
as when the drug is suddenly taken away. The violent 
delirium tremens spoken of by Levenstein I have never 
seen, save in one case, which I treated according to his 
method. When delirium occurs at all, it is usually of a low, 
muttering, harmless kind. For its treatment and that of the 
severe nervous irritability and restlessness sometimes seen, 
the hot bath, followed by the cold douche, is an excellent 
remedy. If the patient is strong I let him remain in it for 
twenty minutes; if weak, from five to fifteen minutes. 
A good reaction is had and the quieting powers of the bath 
enhanced by pouring one or two pails of cold water over 



A 



TREATMENT AGENTS EMPLOYED. 131 



the patient's head and shoulders, or directing upon him for 
a momenta number of fine jets of cold water, with con- 
siderable force. The nozzle should be so arranged that 
from twenty to forty jets may play at the same time. After 
this the body should be thoroughly rubbed with a hair 
glove, until the surface is in a glow, and the patient then 
be put to bed, where gentle perspiration usually follows, 
with considerable relief to the pain in the limbs, shivering 
and sneezing ; oftentimes a quiet sleep, lasting from thirty . 
minutes to two hours, follows. 

A rapid hot bath, followed by the douche or spray, and 
that by thorough rubbing, I find an excellent measure in 
the after-treatment of these cases, it hastening the breaking 
down of old and stimulating the growth of new tissues, 
as also the different secretions. 

The temperature of the bath should never be below 112 
Fahr. 

In some neuralgic patients, the cold douche sometimes 
causes pain afterward. In these cases it should be omitted, 
the hair glove being used freely in its stead. 

Several baths may be given in the course of a day, but I 
rarely find it necessary to give more than two or three in 
the worst cases. 

The bath, too long continued or too often given, will 
sometimes greatly weaken the patient. In debilitated sub- 
jects and those suffering from pelvic pains I find the hot 
sitz bath, followed by thorough rubbing and kneading of 
the whole body, often gives great relief. 

For persistent insomnia I find the cold pack a most 
serviceable agent. The patient is wholly undressed, a 
sheet is wrung out of cold water, and he is wholly envel- 
oped in it up to the chin. The sheet should be folded 
under the feet and tucked in evenly and closely about the 



132 THE OPIUM HABIT. 

neck. He is then closely wrapped in from four to six 
blankets, and in the majority of instances will soon fall 
asleep, a gentle perspiration breaking out all over him. He 
may be allowed to remain in this an hour or even two 
hours. 

Excitement and nervousness are calmed by it, the rest- 
lessness and pain disappear, and the sufferer often remarks 
how much good it is doing him. 

In removing it, the whole matter should be done rapidly, 
under cover of a heavy blanket, and the body be thor- 
oughly rubbed with a sponge dipped in whiskey and water. 

ELECTRICITY. 

This is also a valuable agent in the treatment of the pains, 
that are usually distressing. Sometimes the interrupted, 
sometimes the continuous current acts the best. As a rule, 
however, a powerful continued current (from ten to forty 
cells) is the most serviceable. The electrodes should be 
kept continuously moving up and down the limbs, and the 
current be occasionally reversed. 

Dr. William F. Hutchinson relates the following inter- 
esting case* of cure by electricity : " About the first of 
January of the present year, I was requested by Dr. O. C. 
Wiggin, of this city, to see with him a lady supposed to be 
suffering with cerebral congestion in an advanced stage. 

" A visit to Mrs. S. revealed the following history : Age 
thirty-nine ; married ; one child, aged six ; and has had 
one miscarriage; weight about 150 pounds; and general 
appearance of contour and skin good. Patient kept up a 
low moaning, answering most of my questions intelli- 
gently, then relapsing into a semi-unconscious condition. 
Pulse 100, compressible; temperature 99 ; no loss of 

* (N. Y. Med. Record), Southern Med. Record, Sept. 20th, 1879. 



TREATMENT AGENTS EMPLOYED. 133 

control of evacuations ; conjunctivae congested and pupils 
contracted closely ; perspiration starts upon the smallest 
exertion, which also causes pain in abdomen and excites 
vomiting, which has lately become persistent, accom- 
panied with intense thirst. Hands and feet cold, with 
shriveled palms and plantar surfaces. No difference in 
temperature of head and axilla. 

"Ophthalmoscopic examination gave retinal and cho- 
roidal congestion, with venous enlargement, slight optic 
neuritis and choked disk. 

" There was constant pain, and sense of fullness in frontal 
region. 

" The only family history that could be obtained bearing 
upon the case was the death of one sister, a year ago, from 
acute brain inflammation, the remainder of the immediate 
family being still living and in good health ; and the pre- 
sent condition appeared to be the culmination of six years 
of almost constant pain and general nerve exhaustion, fol- 
lowing the birth of a child, and aggravated by a subsequent 
miscarriage. 

"At this visit no suspicion was entertained by me of any 
opium habit, and the case was diagnosed as passive cerebral 
congestion, dependent upon general neurasthenia. 

" The next day Dr. Wiggin called and gave me the fol- 
lowing additional items, which at once placed the case in 
its proper light and gave the key to many of the symptoms 
before cited. After her confinement, which was a long 
and painful one, she suffered severely from wandering pains 
in back and hips, for which her attending physician at the 
time ordered tincture of opium applied externally, giving 
at the same time ten drops by the mouth, and the ground 
was broken for the building of the habit. The dose 
steadily increased until she came under the charge of Dr. 



134 THE OPIUM HABIT. 

Wiggin, some six months previous to my seeing her, when 
she was taking four ounces of laudanum daily, internally, 
besides continuing external applications as before. 
Attempts were made to stop the pernicious habit, but it 
was too late for wise counsel to avail, and the usual cunning 
of opium eaters procured for her the drug in spite of every 
effort of both husband and physician. 

"All forms of concurrent medication had been faithfully 
tried, but nothing was of use except the opium, to which 
it became absolutely necessary to resort occasionally, as 
without it the poor lady would arouse the neighborhood 
with agonizing screams and cries. 

" At this juncture, as a forlorn hope, it was decided to 
essay galvanism, hoping that its great vitalizing power 
might aid in restoring tone to the exhausted nerve centres. 
At my suggestion, Collis Brown's chlorodyne was given in 
place of laudanum, and produced the same effect with an 
ounce per diem that the four ounces of the former had 
done. 

" Central galvanism was applied, with a twenty-four cell 
Bartlett battery, using six cells from the cilio -spinal centre 
to the forehead, with a downward current; then from the 
cervical vertebrae to the solar plexus, with an ascending 
current, each lasting six minutes, or until the skin was 
thoroughly reddened under the negative carbon point. For 
the first few days applications were made morning and 
night. In a week the vomiting had ceased and conscious- 
ness returned, and the evening sitting was omitted. After 
a month the dose of anodyne was gradually decreased, but 
with every diminution the nausea returned, and nothing 
but a return to the old dose would avail. But her condi- 
tion was very much improved. She slept better, the eyes 
were normal as to color and the palms were no longer dry. 



TREATMENT AGENTS EMPLOYED. 136 

At the close of the second month she was able to sit up, 
and the dose of anodyne was steadily cut down without 
the patient's knowledge, by adding to the chlorodyne a 
sufficient quantity of flavored treacle to replace each dose 
taken, until at that time an ounce would last three days. 

" Her general condition was greatly improved, and she 
began to take interest in her surroundings. In two months 
more she commenced to go out, and came to my office for 
treatment, when I changed the current to the Siemens and 
Halske cabinet cell, which, with its low tension and perfect 
capability of control, I regard as the ideal battery for cen- 
tral galvanism. There was no further trouble, and to-day, 
June 21st, the lady is quite well, attending to all her 
household duties, not having tasted opium in any form for 
seven weeks, and expressing unbounded delight at being 
free from the terrible habit which had so long been her 
master. 

" The rationale of the action of galvanism in this case is 
difficult to understand. When the circuit was closed over 
the superior sympathetic ganglion, Dr. Wiggin and myself 
distinctly observed a sudden wave-like contraction of the 
distended retinal veins, which resumed their size in a few 
moments after the stimulus was removed. But, after some 
weeks' treatment, these veins became normal, and the in- 
traocular congestion had disappeared part passu with the 
cerebral symptom, and having repeatedly witnessed the 
same phenomenon in other cases, I am led to believe that 
the galvanic current has a direct tonic influence upon the 
vaso-motor system, which accounts for the occasional 
surprising results obtained in cases of cerebral congestion. 
With the advent of increased nerve circulation came an 
absolute horror for the drug, and it is not easy to know 
to what to attribute the increase of strength of will up to 



136 THE OPIUM HABIT. 

the point of totally dispensing with it of her own accord, 
unless it be to some change in mental power, due to in- 
creased nerve tone, the direct result of what I have before 
termed the vitalizing power of the galvanic current. 
Faradism was not at any time employed. 

" Dr. Wiggin gives full credit to the special treatment for 
the cure of the case." 

DRUGS. 

The bromides I have found to be very valuable, especially 
where there is a hysterical tendency. The bromide of 
sodium is said to disorder the stomach less than any of the 
others. To be of any service they must be given in large 
doses. Dr. J. B. Mattison gives sixty grains, three times 
a day. I have given as high as three hundred and thirty 
grains in one hour and a half, and often in one hundred 
grain doses, and have never yet seen the least harm result, 
but very decided good. Wyeth's elixir of the bromide of 
potassium is an elegant preparation. Its strength may be 
increased at will. Where there is too decided irritation 
of the stomach I give the drug by the rectum, in milk. 
Occasionally a large dose of the bromide will quiet persist- 
ent nausea. It certainly modifies the excitement and reflex 
irritability, as also the headache and salivation. 

Coca I have tried in several cases, but cannot agree with 
Prof. Palmer as to its peculiar adaptability to these cases. 
As a nerve tonic it is a valuable adjunct to other treatment, 
but beyond that nothing. 

Strychnia, capsicum and belladonna I use in large doses, 
or small doses often repeated. They are all heart stimu- 
lants, and the two former decided nerve tonics, aside from 
their action on the stomach. I vary the quantity of each 
ingredient to suit each case. The use of capsicum was 
first suggested by its successful employment in delirium 



TREATMENT AGENTS EMPLOYED. 137 

tremens. A nervous tonic may at the same time be a 
sedative to nervous irritability. I gradually increase the 
dose as the symptoms are wont to increase, during three or 
four days, and the drugs thus given seem to have a better 
effect. 

If the nervous irritability is extreme, especially if there 
are hysterical symptoms or twitching of muscles, or spasm 
of the rectal or vesical sphincter, I add lobelia and stra- 
monium, which, besides relieving these symptoms, are 
excellent in allaying the nausea and vomiting. 

Cannabis indica is an excellent agent to cause tranquillity 
and destroy hallucinations. It seems to take the place of 
the morphine to a certain extent. It, too, must be given 
in large doses. 

Hyoscyamus and hyoscyamia I have tried, and never 
derived much advantage from them. The former usually 
increases or produces diarrhoea. My failure to obtain 
good results has not been due to using too small doses. 

Chloral, except in small doses, is a dangerous remedy, 
and one with which, if a good effect is had, the patient 
is apt to fall in love. It is not of much service as a sleep 
producer, save in dangerously large doses. Levenstein 
found that in some cases it produced violent excitement. 
I have seen a ten-grain dose produce urticaria that tor- 
mented the patient for several days. 

Hydrocyanic acid was first recommended in the treat- 
ment of this affection by W. C. Blalock.* He claims that 
it supplies the place of morphine or opium. It does not 
do so. His formula reads as follows — 

R . Acidi hydrocyanici dil., . . . gtt.xlviij 
Syr. simplicis, . . . . j| ij 

Aquae, gj. M. 

Sic. — A teaspoonful at 7 A.M., 12 and 8 P.M. 

* (Arianta Medical Journal) Fhysicians' Monitor, 1878 . 



138 THE OPIUM HABIT. 

As a quieter of gastric irritation and nausea, and as a 
nerve stimulant, it is an excellent adjuvant in certain cases. 

Lupulin and Lactucarium, I have not had sufficient op- 
portunity to test these drugs fully, but in one case, which 
I have under treatment now, they seem to take the place 
of morphine with excellent results, the patient going 
twenty- four hours with but a small amount of discomfort on 
a minimum amount of morphine and large amounts of these 
drugs. In three days I have been enabled, by their use, 
to reduce the amount of morphine from twelve grains to 
half a grain, in the twenty-four hours, the patient being up 
and about. Whether the effect will hold, and whether these 
drugs can be easily abandoned, remains to be seen. It is 
in drugs of this class that we must look for a substitute for 
opium and its alkaloid. With other treatment we merely 
combat the symptoms that arise. 

The fluid extract of lupulin may be used in from one to 
four drachm doses, by the mouth, or from thirty to sixty 
drops hypodermically. Lactucarium is best given in 
powder, in half drachm doses. 

I have also used the extract of lettuce (English) in ten- 
grain doses, every two hours. 

DIET AND STIMULANTS. 

In the management of these cases diet is as important as 
medication. With the plan which I am now pursuing I 
rarely have nausea lasting longer than a few hours, a very 
important point, both as regards the comfort of the patient 
and the possibility of full nutrition. Diarrhoea, too, so 
common in Levenstein's plan, rarely proves troublesome, 
is often entirely absent, and I am occasionally obliged to 
use laxative medicine. If there is any tendency to relaxa- 
tion of the bowels I interdict the use of fruit, of which 



TREATMENT AGENTS EMPLOYED. 139 

these patients are very fond, and give subnitrate of bismuth, 
in large doses. 

Beefsteak, beef broth, chicken soup, mutton broth, wine 
jelly, eggs and plenty of milk are called for. With the 
milk a little lime water should be used. If the digestion 
is slow and labored, from ten to twenty grains of pepsine 
should be given after each meal. If there seems to be 
decided gastric catarrh nothing acts so well as pills com- 
posed of — 

R. Argent, nitrat., . . . . gr.A- 
Crcasote, . ... gr.ss. 

One, one hour before meals. 

If there are symptoms of collapse, although this is 
unusual, wine should be given freely, or whiskey hypoder- 
mically, three or four syringefuls at a time. Milk punch is 
an excellent stimulant and food, and egg-nog good, when 
well borne by the stomach, which is not always the case. 

The best wine for these patients is sherry, and it should 
be better than that found in drug stores and bar rooms. 
Port is usually largely adulterated. Claret causes acidity. 
As a rapid stimulant the best champagne is excellent. 
There comes a little apparatus that can be screwed through 
the cork of the bottle, and by turning a faucet as much or 
as little can be drawn as is wanted. It saves wine and 
keeps it from staling. 

Bottled beer is of service in some cases. The purest 
only should be used. It may be kept from staling in the 
same manner as the champagne. 

Alcoholic stimulants should be continued only so long as is 
absolutely necessary, which is never more than ten days. 
This is very important, for it must be borne in mind that 
these patients are prone to go to excess with stimulants, as 
well as narcotics. 



140 THE OPIUM HABIT. 

AFTER TREATMENT. 

The thorough cure of an opium or morphine habitue does 
not consist alone in stopping the use of the drug. This is 
certainly a very important step, but there yet remains much 
to be done, especially in those cases where the person be- 
came habituated to the use of the drug through its employ- 
ment in some extremely painful neuralgic affection. This 
disease may still persist or return /in full force on the with- 
drawal of the drug. 

The use of the drug being discontinued, attention should 
be at once directed to the treatment of the original affec- 
tion or of any disease that may lead the patient to again 
return to the use of the drug. 

There are, too, certain troublesome symptoms, about 
some of which I have already spoken, that come on a few 
days after the opium or morphine is stopped. The most 
troublesome of these is " soreness of the throat," consisting 
in congestion of the pharynx, tonsils, larynx and vocal 
cords. There is a sensation of tickling and a short, dry, 
annoying cough, that comes on in paroxysms and is espe- 
cially troublesome at night. It is best treated by the local 
application of nitrate of silver (twenty to forty grs. to the 
ounce) and five-drop doses of benzoic acid given several 
times daily. 

The insomnia is usually relieved by exercise better than by 
drugs, although I have often found bromide of potassium and 
hyoscyamus of service. On no account use chloral hydrate, 
or give stimulants at bedtime. Exercise is by far the best 
remedy. Walking, running, making garden, etc., suffi- 
cient to tire the patient out thoroughly, is an almost certain 
sleep producer, appetizer and hastener of tissue metamor- 
phosis. The cold pack or a hot bath at bedtime often 
proves of service. 



TREATMENT AGENTS EMPLOYED. 141 

The appetite usually needs no stimulation by drugs. It 
is, as a rule, ravenous for the first few weeks after the mor- 
phine is stopped, so much so that ten-grain doses of pep- 
sine will often be found necessary after each meal, the 
patients usually over eating. As a rule, I give the follow- 
ing mixture, as much for its effect on the nervous system as 
for the appetite : — 

R . Strychnine sulph., .... gr.ss vel gr.j 
Tinct. gentian co., 

Tinct. cinchona co., aa . . § ij. M. 

Sig. — One drachm half an hour before meals. 

If anaemic, nothing acts so well as the muriated tincture 
of iron, which usually contains a trifle of arsenic, in from 
fifteen to forty-drop doses, three times a day, after meals. 
It should be given in half a goblet of water. Cod-liver oil 
is also of great benefit, especially if there is combined with 
it minute doses of the iodide of arsenic. 

Seminal emissions and priapism in males will right them- 
selves. 

Females who suffered from leucorrhcea before they 
commenced using opium or morphine, and who stopped 
during the time they were taking it, as, also, those who 
have never had such a discharge, are usually troubled with 
a white, ropy matter passing away from them in large 
amount. This is sometimes accompanied by severe, labor- 
like pains. Vaginal injections of a strong infusion of white 
oak bark are called for, to be followed by the use of the 
following on the top of pads made of borated or absorbent 
cotton : — 

R . Tinct. iodin comp., . . 5| ss 

Glycerin, . . . . . 5 ij. M. 

These pads are made a little larger than a lemon, with a 
pedicle twisted with fine cord. They are medicated on 



142 THE OPIUM HABIT. 

the top, the sides smeared with vaseline, and are then 
pushed up against the mouth of the womb. A small piece 
of cord is left hanging, so that they can be easily removed. 
They are to be introduced in the morning, and removed at 
night. * 

Neuralgic pains in the limbs and body are best removed 
by the hot bath and massage. 

The menses may come on irregularly, that is to say, not 
at the period at which they usually came before addiction 
to the habit caused their suppression. Pain in the pelvic 
region, fullness of the abdomen, and a general sensation 
of puffin ess, indicate their coming. On the appearance of 
these symptoms I give the following until the bowels are 
freely moved, at about which time the menses usually 
appear: — 

R . Ferri sulphatis, .... gr.ij 
Pulv. aloes soc, 

Pulv. canella, aa g r -i y - M. 

In capsule every night or morning, or the pills of Oppolzer.* 

The period is finally established at its proper time by 
coming on a few days sooner each month until the normal 
date is reached, after which there is rarely any change. 
The second and third menstruation is much more abundant 
and less painful than the first. 

Dyspepsia and "biliousness," which are sometimes 
present, are best overcome by pepsine, and the following, 
every third night, to be followed in the morning by some 
laxative mineral water: — 

R • Mass hydrargyri, 

Ext. colocynth, co., aa . . . gr.iij. M. 

It may be made in pill form or be put in a capsule. 

*H. C. Wood; "Materia Medica and Therapeutics/' p. 440. Phila., 1877. 

J$C. Ferri sulphatis, gr.xx 

Ext. aloes, aq., 5j 

Ext. taraxaci, ....... q.s. M. 

Ft. pil. No. 60. 
Sig. — Two, night and morning. 



TREATMENT — AGENTS EMPLOYED. 143 

Finally, plenty of exercise and fresh air, baths, regular 
habits of life, and treatment directed to those complaints, 
real or imaginary, if still existing, for the relief of which 
the patient first took the drug. 

The rapid way in which these patients gain flesh is some- 
times astonishing. A gain of fifty pounds in a month's 
time is not unusual. 

PROGNOSIS. 

The prognosis is, in the majority of cases, good. A 
cure can be effected in any case, provided the directions 
followed are faithfully carried out, especially in a private 
institution, where absolute control of patient and nurse is 
possible, and where the number of patients is limited. 

Levenstein says: — 

' ' To treat morbid craving for morphia with success, it is 
necessary to decide the principal question, namely, whether 
each individual patient does or does not suffer from 
pathological complaints or chronic disorders requiring 
narcotics for their relief. If he does, it is only necessary 
for the doctor to deprive the patient of the morphia syringe 
and to inject personally, if his time permits of so doing, a 
dose which he thinks sufficient, or else to give the narcotic 
internally. 

"Furthermore, we exclude from the treatment all patients 
weak or exhausted through bodily or mental affliction. It 
is all the same whether the prostration is caused by night 
duty, distress, illness, childbed, want of proper food, flood- 
ing,*etc; only those conditions of weakness following upon 
the poisoning with morphia constitute no counter-indica- 
tion, as they disappear in consequence of the deprivation. 
Only such individuals, therefore, are suited for the treat- 
ment who have continued the injections while in perfect 



144 THE OPIUM HABIT. 

health, the former morbid appearances for which they at 
first administered them having disappeared." 

From these statements I must heartily dissent. No 
organic disease, no affection of the general system, save 
those that are sure to prove fatal, as cancer and the like, 
justify continuance in this habit. In almost every instance 
the accompanying ill effects will be found to be due more 
to the abuse of morphine than to the disease itself. In- 
deed, its continuance may place the patient in a condition 
that will preclude the possibility of recovery. 

Patients with one foot apparently in the grave, when 
deprived of their morphine, take a decided turn for the 
better, and regain fair, if not perfect health. A fatal 
ending sometimes follows the waiting and attempting to 
build up the health before commencing the treatment of 
the habit. 

As to the advisability of treating debilitated and exsan- 
guinated patients by the method of sudden deprivation, I 
fully agree with him, for the trial is as much as a robust 
and healthy individual can bear. By substitution and 
gradual deprivation, however, it can be accomplished 
safely and satisfactorily. 

The danger of a return to this habit decreases with each 
year, each month, each day of abstinence. It is greater 
in neurasthenic patients and those who have taken large 
amounts, or who have not received proper after treatment. 

Under no circumstances should these people be given 
opiates in any form or for any complaint, save when life 
can be saved in no other way, for a relapse is almost certain 
to occur if this is done. Witness the case of the literary 
gentleman already referred to. A single dose may undo 
the work of years. 

In conclusion, I feel that I am warranted in again in- 



TREATMENT AGENTS EMPLOYED. 145 

sisting upon the growing evil of indiscriminate and careless 
use of the hypodermic syringe. The following, from my 
work upon the hypodermic use of morphia, well expresses 
my feelings in this matter. 

"Some of my correspondents, men of ability and in 
large practice, express themselves as very skeptical of the 
truth of the statement that the morphia habit has ever 
been formed by the use of the drug hypodermically. Tes- 
timony from all parts of the civilized world settles this 
matter beyond question. Bartholow, from whose excellent 
little work I have so often quoted, says :* 

" ' The introduction of the hypodermic syringe has 
placed in the hands of man a means of intoxication more 
seductive than any which has heretofore contributed to his 
craving for narcotic stimulation. So common now are 
the instances of its habitual use, and so enslaving is the 
habit when indulged in by this mode, that a lover of his 
kind must regard the future of society with no little appre- 
hension. It may well be questioned whether the world 
has been the gainer or the loser by the discovery of 
subcutaneous medication. For every remote village has 
its slave, and not unfrequently several, to the hypodermic 
syringe, and in the larger cities, men in business and in 
the professions, women condemned to a life of constant 
invalidism, and ladies immersed in the gayeties of social 
life, are alike bound to a habit which they loathe, but 
whose bonds they are powerless to break. Lamentable 
examples are daily encountered, of men and women, re- 
gardful only of the morphia intoxication, and indifferent 
to all the duties and obligations of life, reduced to a state 
of mental and moral weakness most pitiful to behold. 

" ' Usually the habit is formed in consequence of the 

* " The Hypodermic Method," etc., p. 90. 



146 THE OPIUM HABIT. 

legitimate use of the hypodermic syringe in the treatment 
of disease. Employed in chronic painful maladies for a 
long period, it is discovered, when an attempt is made to 
discontinue the injections, that the patient cannot or will 
not bear the disagreeable, even painful, sensations which 
now occur. More frequently, when the injections are to 
be used for a long time, the patient is unwisely intrusted 
with the instrument, and taught all the mysteries of the 
solutions and the mode of administration.' 

"A study of the opinions and cases that I have collected 
and presented in the preceding chapters furnishes abun- 
dant food for thought; the more so, as nearly every phy- 
sician in the world is using a hypodermic syringe with more 
or less frequency. Many are unquestionably using this 
instrument too often ; are using it in cases where the same, 
or other remedies, by the mouth, would be equally effica- 
cious, and certainly safer. Far be it from me to condemn 
the use of an instrument the employment of which has 
brought both temporary and permanent relief, sometimes 
cure, to thousands suffering the most intense agony. Its 
value in cases especially suited to it cannot be over-esti- 
mated; its use in cases unsuited to it, or where other 
means would answer as well, cannot be too strongly and 
heartily condemned. Death, syncope, alarming narcotism, 
and, perhaps, more important than all, that living death — 
the morphia habit — bids us choose our cases well, and 
continue its use for only so long a time as is absolutely 
necessary. 

"It would seem, from a study of the cases related under 
the latter head, and from many of the interesting letters 
for which I cannot find space, and, therefore, give at second- 
hand, that so long as the drug is used carefully, and with 
discrimination, by the physician, the morphia habit is little 



TREATMENT AGENTS EMPLOYED. 147 

apt to result, and that it may be broken off when once 
formed, although the amount of morphia used is large. 
But, nevertheless, even when these results are attained, 
persons, especially those of the neurasthenic type, will 
often procure a hypodermic syringe surreptitiously, and 
continue, commence or re-commence the practice anew. 
For this the physician is certainly not to blame, but the 
fact still stands, and the question arises whether relief by 
other means, though less prompt and less permanent, would 
not have been more preferable to the deplorable mental, 
moral and physical condition that almost uniformly obtains 
when the habit is once established. 

"When Wood first gave his idea to the world, and when 
that idea was practically developed and extended in point 
of applicability by Hunter and others, it was thought to 
be glory enough to have found a weapon sufficiently pow- 
erful to cope with severe and obstinate neuralgia and dis- 
eases that would not yield to other treatment. To-day, as 
seen from its journal literature, the subcutaneous method of 
giving morphine has become almost universal, and it is 
employed for complaints of the most trivial character. 
Aside from the immediate and remote danger of thus need- 
lessly extending this practice, there is another reason why 
this instrument should not be so commonly employed— 
there is apt to be slurring of diagnosis and a blind treat- 
ment of the most prominent symptom. This is especially 
the case with the younger members of the profession. 
Having relieved the pain, they fail to study the minor 
symptoms, to look at patient's family and personal history, 
to be observing of skin, and tongue, and pulse. It may be 
urged that the patient often recovers without any other 
treatment. True ! But many do not, and the lack of 
study of every point in the successful cases bears its fruit of 



148 THE OPIUM HABIT. 

slovenly diagnosis and unscientific treatment in many suc- 
ceeding cases. 

" Finally, let it be distinctly understood that I consider 
the hypodermic use of morphia a very decided therapeutic 
advance, and of incalculable benefit in allaying pain and 
curing disease in cases where other modes of treatment 
utterly fail. In calling attention to the dangers sometimes 
attending the use of the drug in this way, I do it not from 
a one-sided view of the question, not with a desire to con- 
demn it, simply to point out what may occur, endeavor to 
show how best to avoid it, and, if possible, restrict its use 
to those cases in which it is proper. ' ' 

The physician should never entrust a syringe or the 
solution to patients or their friends. He should use it 
himself. 



THE CHLORAL HABIT. 



CHAPTER VIII. 

THE CONTINUED USE OF CHLORAL HYDRATE. 

But little attention has been paid in this country to the 
habitual use of chloral. German and English literature is 
more abundant, but at best vague and unsatisfactory, and 
the professional mind does not seem to be at all settled upon 
the subject as to whether such a thing as a chloral habit 
does or does not exist. 

A committee was appointed by the Clinical Society of 
London, a short time ago, to investigate this matter. The 
result was a failure, owing to the fact that the medical 
gentlemen who received circulars asking for information 
upon various points failed to answer in sufficient numbers 
or with sufficient explicitness to make the results valuable. 
There were but seventy replies from the thousand circulars 
sent out. 

Not knowing until afterward of the work then under- 
taken by that society, I prepared and sent out some ten 
thousand circulars, containing a series of questions upon 
chloral, one of which related to the habitual use of the 
drug. To this circular I received over four hundred 
replies, one hundred and seven of which related to the 
chloral habit. 

149 



150 THE CHLORAL HABIT. 

One hundred and seven physicians reported 135 cases 
where the long continued use of the drug had led to a more 
or less marked craving for it. 

An analysis of these cases may prove of interest. 

The ages of the patients were obtained in ninety-four 
instances, and show as follows : — 

From 20 to 30 . . . 12 

From 30 to 40 . . . -25 , 

From 40 to 50 . . . 27 

From 50 to 60 . . . -19 

From 60 to 70 . . . n 

94 
The sex was obtained in one hundred and thirteen cases, 
as follows : — 

Males . . . . -77 

Females . . . . . 36 

113 

There were among the number clergymen, physicians, 
editors, clerks, prostitutes, mechanics, farmers and hospital 
nurses. 

The majority of the females were married women, suffer- 
ing from painful uterine complaints. The majority of the 
males, persons who had been or were addicted to the use 
of alcoholic stimulants. Some, both males and females, 
formed the habit through taking it for insomnia and mental 
depression, dependent on family troubles, business failures 
and the like. Some through hearing or reading of its 
magical effects and trying it to satisfy themselves. 

In many important points the habitual or long continued 
use of chloral differs from that of opium or morphine, viz : 

1. Many persons take it for years without any obvious 
ill effect. 



CONTINUED USE. 151 

2. Its continued use is not so liable to be followed by a 
morbid craving for it as for morphine or opium. 

3. The habit once formed is, in the majority of instances, 
easily broken. 

4. An abrupt change from chloral to some other nar- 
cotic is often made. 

As regards the first and second propositions the following 
facts may be taken into account : — 

Dr. W. M. Compton,* Medical Superintendent, Insane 
Asylum, Jackson, Miss., says that he has given twenty to 
thirty-grain doses of chloral hydrate nightly, for years, to 
noisy patients, without observing any ill effects. Dr. J. 
H. Nordlin,f of Rome, Ga., has given it in combination 
with bromide of potassium, capsicum and ammonia, in 
asthma, for a long time, without any ill effects. 

A correspondent of the London Lancet, \ a medical man, 
says that, for sleeplessness, he has been obliged to take 
twenty-grain doses of chloral at bedtime, for upward of 
four years, without any bad consequences whatever. 

Dr. J. G. Thornley§ has used chloral in the treatment of 
insane persons, continuing its use for from six months to 
two years, without any ill effects. 

Dr. Schlaugenhausen, First Assistant Physician to the 
Lunatic Asylum, Hall, Tyrol, writes me that in a case of 
insanity he gave thirty grains of chloral every night, for 
six years, without any perceptible bad effect. He says that 
he has never seen a case where there was a morbid craving 
for chloral, such as is seen from opium or morphine. Dr. 
John Wirtinger, of Ybbs on the Danube ; Dr. Reiman, of 
Kiev, Russia, and Dr. Fr. Akland, of Stockholm, Sweden, 
write the same. 

* N. Y. Medical Record, 1876, p. 436. f By letter. 

% April 14th, 1877. § Lancet, Dec. 18, 1875. 



152 THE CHLORAL HABIT. 

Dr. A. Ady,* of West Liberty, Iowa, gave chloral in a, 
case of chronic diffuse nephritis, for nearly a year and a 
half, without any bad results and with no tendency to the 
formation of a habit. 

Bidlackf relates a case where this drug was used for a 
year, with no bad effects. 

Lawrence Turnbull j gave chloral, in medicinal doses, for 
one year, as a sedative and narcotic. Its use was stopped 
at once, without any ill effects whatever. Dr. Blackwood§ 
used thirty grains three times a day, in combination with 
bromide of potassium, for three months. No bad effects 
beyond slight conjunctivitis. No evil effects followed the 
withdrawal of the drug. 

Dr. Carlos F. MacDonald || writes: " As regards the 
so-called ' chloral habit,' I can only say that I have used 
chloral very largely in my practice — commencing with its 
introduction to the notice of the profession in America — 
and I have yet to meet with a case." 

A physician, who does not wish his name used, took 
twenty grains at bedtime, for insomnia, for nearly two 
years and a half, without ill effect. Professor A. A. Smith, 
of Bellevue College, this city, writes me: "A lady of an 
extremely nervous temperament had it administered to her 
during an attack of typho-malarial fever. This was seven 
years ago, and she has taken it every night of her life 
since. Usually ten grains suffices, bulf sometimes she takes 
thirty grains. It has had no perceptible bad effect. She 
seems perfectly well. I have, time and again, tried to 
wean her from the habit, but to no purpose, and I am 
quite certain that the drug has never yet done her any 
harm." 

* Letter. 

f Philadelphia Medical and Surgical Reporter , Nov. 9, 1878. 
% Ibid. I Ibid. 

|j American Journal of Insanity , 1878,, p. 367. 



CONTINUED USE. 153 

Dr. G. A. Shurtleff, Medical Superintendent State Insane 
Asylum, Stockton, California, writes me that he has seen 
a morbid desire for chloral produced by the taking of 
from twenty to forty grains regularly at bedtime, to pro- 
cure sleep. It was easily broken, the desire passing away 
in a few days. 

Dr. M. L. Holbrook, of this city, writes me of the case 
of a highly cultured lady, an authoress, now in Germany, 
who had taken thirty grains of chloral nearly every night, 
for eight years, without the production of a morbid craving 
or other ill effects. 

Dr. Joseph Parrish, of Burlington, N. J., writes me of 
the following curious case: — 

"I have known persons (and have one under treatment 
at this time) who are habituated to the use of narcotics, 
and who, to avoid being enslaved by either one, alternate 
between morphia, chloral, whiskey, and the bromides, 
with the result of rest and composure from each in its 
turn. They are not opium or chloral habitues, nor ine- 
briates from alcohol, but they are habituated to artificial 
narcotism. 

. "In the case now under treatment, the chloral dose does 
not exceed fifteen grains at bedtime, and the morphia dose 
does not exceed half a grain, nor the whiskey dose more 
than a fluid ounce. I learn from the patient that his for- 
mer physician employed these remedies for long-standing 
insomnia. 

"Present condition fair; i. e., delicate constitution, but 
good appetite, and even temperament ; functions not inter- 
fered with, though the habit of taking something to pro- 
mote rest and sleep is of several years' duration." 

The following is from a prominent physician, who does 
not care to have his name appear in connection with the 
case: — 



154 THE CHLORAL HABIT. 

"A lady patient of mine — now fifty-seven years of age 
— began to take fifteen grains of chloral about eight years 
ago, after very great family affliction, to procure sleep, and 
has kept up its use almost uninterruptedly ever since, without 
increasing the dose, though she occasionally (not very 
often) repeated the dose once during the night. During 
seven of these eight years she was subjected to the depress- 
ing influence of the care of a child with severe epilepsy 
and mental deterioration slowly progressing. During the 
last year she has gone several times, for a week at a time, 
without the drug, and I think that she could now dispense 
with it almost entirely were it not for constant anxiety 
about one of her children. She takes it only to procure 
sleep; and I cannot see that it has harmed her in any 
way. 

"The above case cannot be called one of the chloral 
habit, as during a number of hours out of every twenty-four 
she is free from the influence of the drug ; but I think the 
case may be of value as illustrating the length of time 
during which the drug may be taken, almost daily, without 
any increase of dose." 

Professor Henry M. Lyman, of Rush Medical College, 
Chicago, writes as follows: — 

' ' I am acquainted with a clergyman, sixty-five years of age, 
whose mother died insane. He informs me that for ten 
years past he has been obliged, in order to procure sleep, 
to take ten grains on retiring, and ten grains more about 
3 a.m. His health is otherwise good, and he is possessed 
of more than common intellectual power. He, however, 
though never in the habit of using alcoholic drinks, has 
the red eyes and rather ( groggy' appearance of a person 
who drinks too much. I have known of other cases where 
persons were in the habit of taking ten grains at bedtime, 



CONTINUED USE. 155 

every night, for months together, with great benefit. I 
have never happened to make the acquaintance of a person 
who was addicted to its use as a simple instrument of 
pleasure. ' ' 

Some men, in the early history of this drug, and some 
at the present day likewise, lauded it highly as a substitute 
for opium, claiming for it perfect freedom from the danger 
of forming a habit and the non-production of ill effects 
when used for a long time. 

Thus a correspondent of the Doctor* says : — 

"Long-continued use does not impair the general health. 
I know persons who have taken it almost since its intro- 
duction, in the same dose and with the same success. ' ' 

Dr. Pollakf says: "The prolonged employment of 
chloral is not usually attended with any disagreeable effects, 
and if any such occur, they are of no consequence. It 
especially does not induce congestion of the brain or dis- 
turbance of the digestive organs. ' ' 

Dr. C. W. Cram,j of Columbus, Ohio, writes: "Its 

use is not followed by that craving for its continuance 

which so often attends the administration of preparations 

of opium, especially morphine, producing a multitude of 

" opium-eaters." 

Others went to directly the opposite extreme. 

Dr. Madison Marsh § says: "Its effects are so pleasant, 
its use so exquisitely fascinating, that, the habit once ac- 
quired, a person becomes a slave to its use, never to stop 
till death closes the scene. The enchantments of alcoholic 
stimulants, cannabis Indica, morphine or tobacco, bind 
with silken cords, compared to the bars and hooks of steel 

*New York Medical Record, 1872, p. 106. 

f Wiener Med. Wochenschrift , Feb. 28, 1874. 

J The Clinic, March 2, 1872. 

I Philadelphia Med. and Surg. Reporter, Jan. 16, 1875. 



156 THE CHLORAL HAEIT. 

thrown around the unhappy victim of this popular drug 
and infatuating stimulant." 

The first to call attention to the possibility of the forma- 
tion of a "chloral habit" was Dr. B. W. Richardson, of 
London, a part of whose most excellent paper* I cannot 
refrain from giving. 

" It is a matter of deep regret to have to report that, 
since the name was given to the disease, chloralism has 
become widespread. It has not yet spread far among the 
female part of the community. It has not yet reached the 
poorer classes of either sex. Among the men of the 
middle class, among the most active of these in all its 
divisions — commercial, literary, medical, philosophical, 
artistic, clerical — chloralism, varying in intensity of evil, 
has appeared. In every one of these classes I have named, 
and in some others, I have seen the sufferers from it and 
have heard their testimony in relation to its effects on 
their organizations. Effects exceedingly uniform and, as 
a rule, exceedingly baneful. 

"At the meeting of the British Association for the Ad- 
vancement of Science, held in Edinburgh, in the year 
1 87 1, I drew earnest attention to this subject. I said, and 
the words were published in the reports of that year (p. 
147), there is another subject of public interest connected 
with the employment of chloral hydrate. I refer to the 
increasing habitual use of it as a narcotic. As there are 
alcoholic intemperants and opium eaters, so, now, there 
are those who, beginning to take chloral hydrate to relieve 
pain or to procure sleep, get into the fixed habit of taking 
it several times daily, and in full doses. I would state 
from this public place, as earnestly and as forcibly as I 
can, that this growing practice is alike injurious to the 

* Druggists' Circular and Gazette, Nov., 187Q 



CONTINUED USE. 157 

mental, the moral, and the purely physical life, and that 
the confirmed habit of taking chloral hydrate leads to in- 
evitable and confirmed disease. Under it the digestion, 
natural tendency to sleep, and natural sleep are impaired ; 
the blood is changed in quality, its plastic properties and 
its capacity for oxidation being reduced ; the secretions 
are depraved, and the nervous system losing its regulating, 
controlling power, the muscles become unsteady, the heart 
irregular and intermittent, and the mind excited, uncertain, 
and unstable. To crown the mischief, in not a few cases, 
already, the habitual dose has been the last ; involuntary, 
or rather, unintentional suicide closing the scene. I press 
these facts on public attention not one moment too soon, 
and I add to them the further facts that hydrate of 
chloral is purely and absolutely a medicine, and that 
whenever its administration is not guided by medical 
science and experience, it ceases to be a boon and be 
comes a curse to mankind. 

" This was stated within two years after the substance, 
chloral hydrate, came into medical use. If at that time 
the mind of the public had been as ripe as it is now for 
the acceptance of the truth, or if I could then have reached 
the ear of the public more plainly, much evil might have 
been nipped in the bud. As it was, the warning had little 
effect, except to expose me to adverse criticism as an 
alarmist, and the evil has gone on with increasing rapidity 
and mischief. There is, at the present time, a considerable 
community addicted to the habitual use of chloral hydrate, 
on one pretence or another, and a learned medical society 
has recently framed a series of written questions on the 
subject, which questions it has felt it expedient to address 
to members of the profession of medicine generally, for 
their replies. 



158 THE CHLORAL HABIT. 

' ' The persons who become habituated to chloral hydrate 
are of two or three classes, as a rule. Some have originally 
taken the narcotic to relieve pain, using it, in the earliest 
application of it, for a true medicinal and legitimate object, 
probably under medical direction. Finding that it gave 
relief and repose, they have continued the use of it, and at 
last have got so abnormally under its influence that they 
cannot get to sleep if they fail to resort to it. A second 
class of persons who take to chloral are alcoholic inebriates 
who have arrived at that stage of alcoholism where sleep is 
always disturbed, 'and often nearly impossible. These 
persons at first wake many times in the night, with coldness 
of the lower limbs, cold sweatings, startlings, and restless 
dreamings. In a little time they become nervous about 
submitting themselves to sleep, and before long habituate 
themselves to watchfulness and restlessness, until a con- 
firmed insomnia is the result. Worn out with sleeplessness, 
and failing to find any relief that is satisfactory or safe, in 
their false friend, alcohol, they turn to chloral, and in it 
find for a season the oblivion which they desire, and which 
they call rest. It is a kind of rest, and is, no doubt, better 
than no rest at all, but it leads to the unhealthy state we 
are now conversant with, and it rather promotes than 
destroys the craving for alcohol. In short, the man who 
takes to chloral after alcohol enlists two cravings for a 
single craving, and is double shotted in the worst sense. 

"A third class of men who become habituated to the 
use of chloral are men of extremely nervous and excitable 
temperament, who by nature, and often by labors in which 
they are occupied, become bad sleepers. A little thing in 
the course of their daily routine oppresses them. What to 
other men is passing annoyance, thrown off with the next 
step, is to these men a worry and anxiety of hours. They 



CONTINUED USE. 159 

are over susceptible of what is said of them and of their 
work, however good the work may be. They are too elated 
when praised, or too depressed when not praised or dis- 
praised . They fail to play character parts on the stage of this 
world, and as they lie down to rest they take all their cares 
and anxieties into bed with them, in the liveliest state of 
perturbation. Unable in this condition to sleep, and not 
knowing a more natural remedy, they resort to the use of 
such an instrument as chloral hydrate. They begin with a 
moderate dose, as occasion seems to demand, and at last, 
in what they consider a safe and moderate system of em- 
ploying it, they depend on the narcotic for their falsified re- 
pose. Among these classes of men the use of chloral hydrate 
is on the increase. The use is essentially a bad business at 
the best, and while I do not wish in the least to exaggerate 
the danger springing from it, while, indeed, I am will- 
ing to state that I have never been able to trace out a series 
of fatal organic changes of a structural character from such 
use, I have certainly seen a great deal of temporary disturb- 
ance and enfeeblement from it, without any corresponding 
advantage that might be set forth as an exchange of some 
good for some harm. The conclusion I have been forced 
to arrive at is, in brief, to this effect, that if chloral hydrate 
cannot be kept for use within its legitimate sphere, as a 
medicine to be prescribed by the physician, according to 
his judgment, and by him as rarely as is possible, it were 
better for mankind not to have it at any price." 

A case showing the evil effects of the continued use of 
chloral in large doses, and aptly illustrating how readily 
some of these patients pass from the use of this drug to 
alcoholic stimulants and vice versa, is related by Dr. T. 
Inglis,* of the Royal Edinburgh Asylum. I here give an 
abstract of his very interesting article. 

* Edinburgh Medical Journal, Sept. 1877, p. 211. 



160 THE CHLORAL HABIT. 

"F. S. P., shopkeeper, male, aged forty-seven. Patient's 
father died of kidney disease, at an advanced age. Mother 
"nervous," died of paralysis. Two sisters neurotic and 
eccentric. Brother a confirmed dipsomaniac, died of 
brain softening. Patient a man of average intelligence, 
neurotic temperament, previous general good health, but 
has had asthma. Habits teetotal for ten years, up to three 
weeks before admission. 

" Seven years before was ordered chloral and bromide 
of potassium, for relief of spasmodic retention of urine. 
Of these he took about one drachm each, daily, for six 
years regularly, and during that time neither he nor his 
friends noticed any ill effects on either mind or body. 

" At the end of this time he had an attack of bronchitis, 
for the dyspnoea attending which he was given chloral, 
without bromide. Recovery from bronchitis was rapid. 
Death in his family and other troubles, however, led him 
to the continued use of the chloral. Commencing with 
sixty grains daily, he came to use one hundred and eighty 
grains daily. This in ten-grain doses, often repeated. 
Effect not hypnotic, but calmative and soothing. 

" No headache or vertigo were complained of, but there 
was lassitude, nervous debility and exhaustion ; irritability 
of temper and peevishness. Anorexia, acidity, nausea and 
vomiting appeared. Piles became troublesome and the 
faeces white and hard. 

6 'Intellectual enfeeblement and perversion of affective life 
and character. He became untruthful and deceitful, and 
manifested a dislike for home and family. Even threat- 
ened violence to his wife. Three weeks before admission 
he discontinued using chloral, and kept himself in a chronic 
state of muddle and confusion, by means of whiskey. In a 
day or two he became restless, excited and quite unman- 



CONTINUED USE. 161 

ageable. Diarrhoea set in, with great discharge of blood 
from the bowels. A state resembling delirium tremens 
came on. Imaginary voices mocked him; he saw loath- 
some animals, snakes, etc. What little sleep he had was 
broken by terrible dreams. This terminated in three 
severe and unmistakable epileptiform convulsions, at in- 
tervals of four hours. This was followed by stupor, and 
that by excitement. 

ON ADMISSION. 

"Man of average height and development, but seems to 
be prematurely old and broken down. Very weak and 
anaemic, can speak only in an undertone, and can hardly 
walk. 

"Expression blank and vacant. Eyes dull and meaning- 
less. Great enfeeblement of mind. Silly, childish, and 
almost imbecile. No excitement, but, rather, slight de- 
pression of mind. Would laugh and cry without adequate 
cause. No interest in surroundings. Replies to questions 
rambling, incoherent and disconnected, being unable to 
carry on a consecutive line of thought. Memory almost 
obliterated. Could not tell his age or where he came 
from. Had vague, fleeting delusions on various subjects. 

' ' Persistent muscular tremulousness of upper and lower 
extremities, requiring assistance in walking, while the finer 
acts of coordinative power, as writing and whistling, could 
not be performed at all. Tongue furred in the centre, 
tremulous and with fibrillary twitching at the edges, and 
pointed markedly to the right side. Articulation thick 
and indistinct. Pupils equal, dilated, irregular at margins, 
and insensible to light. Right side of face partially para- 
lyzed. Reflex action of cord much impaired. Common 
sensation acute, verging on hyperaesthesia. Complained 



162 THE CHLORAL HABIT. 

of sleeplessness and exhaustion, but had no headache nor 
neuralgic pains. 

"No cutaneous eruption. Muscles poor and flabby. Con- 
junctivae yellow. Respiratory and circulatory system nor- 
mal. Pulse 67, weak and thready. Temperature 97 . 
Urine, specific gravity, 1.005. Neither albumen, sugar, 
bile nor tube casts. Could only make water at night, 
when it was passed in large quantities, was clear and limpid, 
resembling that of hysteria. Bowels confined, faeces hard 
and of a white color. 

" Neither narcotics nor alcoholic stimulants were used. 
Tonic mixture, containing strychnia, prescribed. Im- 
provement in all the symptoms marked and rapid. Dis- 
charged, well, physically and mentally, in* three months' 
time." 

This case illustrates, also, the fact that the majority of 
those who become habituated to chloral, and in whom it 
works the most serious injury, are of the neurasthenic type, 
and manifest a morbid craving for some stimulus or nar- 
cotic. 

Of the cases where I have been able to obtain informa- 
tion upon this point, I find the temperaments given as 
follows : — 

Nervous, 63 

Sanguine, .... 1 

Nervo-sanguine, .... 8 

Melancholic, . . . . 21 

93 

In forty-one cases there is a history of either nervous- 
ness, nervous disease, insanity, alcoholism or opium addic- 
tion in the ancestors. 

In many of these patients there is a "mixed" habit, as 



CONTINUED USE. 163 

opium and chloral, alcohol and chloral, alcohol, chloral 
and morphine, chloral and chlorodyne, etc. 

It is largely used* by the intemperate as a substitute for 
alcohol. On this point the testimony is abundant and 
positive. 

As an example of hereditary tendency, etc., the follow- 
ing, sent me by Dr. N. Jasper Jones, of Blairstown, Iowa, 
is very interesting: — 

" Alcoholism prevalent in the family, also the opium 
habit, but no insanity, although the mother, at times, under 
mental worry, becomes somewhat unreasonable, as though 
she might become insane. Father died of heart trouble 
while sitting at breakfast. The entire family are of the 
most intense nervous type, on the mother's side, all the 
children taking after the mother ; but the father was un- 
usually reserved and cautious, probably because he had 
schooled himself to be so, on account of his wife's and chil- 
dren's excitable natures." 

It will be seen, from the foregoing cases, that while 
there is no doubt that in certain individuals a morbid 
craving for chloral may be established by the prolonged 
use of the drug, it is very different, as a habit, from that 
produced by opium or morphine. As an offset to this 
stands the fact that, in those cases where a habit is formed, 
it causes a more complete and rapid ruin of mind and body 
than either opium or morphine. 

Persons addicted to the habitual use of this drug are 
usually of the educated class, as is the case with opium. 

It has been denied by some authors that it is ever used 
as a stimulant to the mind. In one case now under my 
care, and in several reported to me by correspondents, this 
was the object for which it was first taken, and it was 

*Dr. A. P. Hayne, Med. Supt. Inebriate Asylum, San Francisco, Cal. 



164 THE CHLORAL HABIT. 

found to answer the purpose admirably, especially in the 
case of those doing continuous literary work. This effect 
was, however, short-lived and the reaction decided. 

Dr. Quintius C. Smith, who has had a large professional 
experience among the prostitutes of the Pacific coast, writes 
me that the drug is or was used largely by this class, they 
finding it quite as efficient a stimulant, nerve sedative and 
sleep producer, as opium or alcohol, and having the ad- 
vantage of leaving no ill after effects. One such patient, 
unless she previously took a dose of chloral, would have a 
severe epileptiform convulsion at each connection. 

A clearer idea of the ill effects of the long-continued use 
of chloral in large doses is best studied on each system or 
apparatus separately. Unlike morphine, it not only shows 
its baneful effects on the nervous system, but it acts to 
directly undermine the health by disorganizing the blood. 



EFFECTS ON THE SYSTEMS. 165 



CHAPTER IX. 

EFFECTS OF CHLORAL ON THE DIFFERENT SYSTEMS AND 
APPARATUSES. 

As I said in my last chapter, it is not every person who 
uses chloral for a lengthened period who becomes an hab- 
itue, and it is not every habitue who is affected in every 
way as fully or completely as in the manner about to be 
described. In each individual the organs chiefly affected 
and the length of time necessary to produce the effect vary 
according to idiosyncrasy, which simply means peculiar 
personal susceptibility. This same fact holds good with 
reference to opium and morphine, as well as chloral. 

MIND. 

The effect of the long continued use of this drug on 
the mind is, in the majority of instances, much more rapid 
and distinct than that of opium. At first there is a tran- 
sient period of stimulation, followed by gradual weakness 
and cloudiness of intellect, mental hebetude, apathy to 
what is going on around. A low species of cunning is 
usually developed, that leads to the planning of plausible 
excuse and subterfuge to obtain a full supply of the drug. 
This condition is well illustrated by the following : — 

Dr. Wm. Kirkpatrick Murphy* reports three cases of 
chloralism — 

i . Lady, fifty-eight ; spare but muscular, and of more than 
ordinary intelligence and strength of will. Took morphine 
for some time, to overcome sleeplessness due to painful 

* London Lancet, Aug. 2d, 1873. 



166 THE CHLORAL HABIT. 

affection of the bladder. Six months before Dr. M. saw 
her she had been taking chloral, twenty grains at night, to 
commence, finally one hundred and fifty grains in the 
twenty-four hours. At his first visit found her almost a 
skeleton, hard to rouse, maudlin and semi-narcotized. 
When questioned, answered wildly and disjointedly. State 
of mind closely bordering on imbecility. Pupils dilated. 
Pulse slow, feeble and intermittent. Face flushed and 
anxious. This had been her condition for many weeks. 
Her rare lucid intervals were spent in childish whining 
for more chloral, or in cunning attempts to deceive her 
attendants and obtain an extra dose surreptitiously. From 
having been a cheerful, upright, exceptionally intelligent 
and strong-willed woman, she had become morose, deceit- 
ful, and imbecile alike in intellect, memory and will. 

Points of exceptional interest. 

i. Marked decubitus, with not mere indisposition, but, 
at times, manifest incapacity for exertion. 

2. Dark, erythematous flush over head and neck, with 
extraordinary twitching of facial muscles. 

3. Partial paralysis of the oesophagus, not spasmodic 
stricture ; but sluggish and incomplete contraction of the 
muscles of deglutition, with regard to both food and drink. 
This was well marked in Case 2, and in both recurred at 
intervals for many months \ even after convalescence was 
established. 

4. Dimness of sight ; eyes bloodshot and constantly 
watering. Once, after total cessation of chloral, tempor- 
ary loss of vision, lasting, with intervals, two days. 

5. Dryness of the hair. 

Case 2. — Lady, aged forty-five, good health and keen 
intellect. Insomnia from worry and from dyspepsia. Had 
taken chloral for two years. At first only at bedtime ; 



EFFECTS ON THE SYSTEMS. 167 

after a time during the day also. Never above seventy 
grains in twenty-four hours. Both physical and mental 
exhaustion, morbid fear, confusion of mind, lack of concen- 
tration and impairment of memory. (She was, however, 
an authoress, apparently doing her regular literary work. 
-K.) 

POINTS OF INTEREST. 

i. Erythema of head and neck. 

2. Excessive hypersemia after smallest quantity of wine 
or beer. 

3. Partial paralysis of the oesophagus, with nervous dis- 
inclination to take food or drink. 

4. Dimness of sight, with eyes bloodshot and overflowing 
with tears. Marked projection of eyeballs. 

5. Intense nausea, oftentimes, after taking chloral. 

Intense melancholia, with suicidal tendencies, halluci- 
nations and delusions, delirium. Acute and chronic mania, 
have resulted. A condition, seemingly a cross between 
idiocy and softening of the brain, sometimes occurs, the 
patients crying at the most trivial things, and bemoaning 
their persecution by what would to others appear to be 
but trifles. The moral nature is profoundly affected, but 
the tendency to lie does not seem to be so distinct as in 
the opium habit. 

Delirium is not so often found while the patient is taking, 
as when he stops the drug. In some cases it does not even 
occur then, but when so happening, is usually very 
violent. 

Convulsive seizures are rare, but do occur, as has been 
shown by the labors of the Clinical Society, of London. 
Two of my correspondents speak of such cases. In both, 
the character of the attack was epileptiform, and occurred 



168 THE CHLORAL HABIT. 

in persons who had used large doses of the drug for a long 
time. 

A mind greatly enfeebled by the continued use of 
chloral is sometimes thrown completely from its balance 
by the effects of an overdose, or the unusually intense 
action of an ordinary dose, an accident that is liable to 
take place at any time. Such a case is related by Dr. 
Willis P. King,* of Sedalia, Mo., as follows : — 

" Mrs. S., aged forty years, first began to use chloral 
during an attack of rheumatism. Has now been taking it 
for some years. Dose about 32 grains, taken from three 
to five times a day. I was treating her for acute rheu- 
matism, and allowed her, by her request, to take an 
occasional dose of a solution that she had been using for 
years. She begged for more than I was willing to allow, 
and, in the absence of the nurse, got up, and, from the 
amount missing, must have taken anywhere from 100 to 
200 grains. I found her, three hours afterwards, in pro- 
found stupor, pulse small and 190 per minute, respiration 
rapid and stertorous, extremities cold. Under stimulation, 
etc., she recovered consciousness after a few hours, but 
was insane, and was sent to the Missouri Insane Asylum, 
where she was treated for acute mania. She was always 
1 flighty ' before she went to the asylum ; on her return 
from there her mental condition was greatly improved.' ' 

The temper becomes irritable, peevishness is developed, 
friends and acquaintances are shunned, and the patient 
lives in a world of his own, built by the warped and dis- 
torted outcome of a diseased imagination. The delusions 
and hallucinations are more often terrifying than pleasant, 
varying, however, somewhat, with the mental peculiarities 

* Letter to the Author. 



EFFECTS ON THE SYSTEMS. 169 

of the victim. The following interesting case is sent me 
by Dr. D. N. Kinsman, of Columbus, Ohio : — 

" Patient's age, twenty-four years. Had been surrounded 
by a set of vicious companions, and got to drinking -ex- 
cessively. Had an attack of delirium tremens, for which 
chloral, bromide of potassium and valerian had each been 
prescribed. In a fit of virtuous indignation at his oft- 
repeated falls, he signed a ' Murphy pledge.' Having 
learned the value of chloral for the horrors, now, in his 
abstinence from alcohol, he began the use of chloral. He 
would sit in the office and sleep in his chair, day after day. 
His speech became drawling and indistinct, and he couM 
not remember what he read. At the end of two or three 
weeks he had an eruption appear on his face, neck, and 
shoulders, like acne. These pimples, at first hard and 
red, suppurated, being attended with much soreness and 
pain. 

" After being in this condition for some weeks he began 
to hear voices at night, rose from his bed in great terror, 
and ran to his father's room, saying burglars were in the 
house, on several occasions. His neighbors were in a con- 
spiracy against him \ living in a double house, could hear 
them planning against him, through the walls. On going 
home at night would go at full run, waiting till very late, 
to have the streets deserted ; asserted he was often pursued 
by a ' band of niggers' who had been hired to injure him. 
Heard people talking about him, whom he passed, even . 
when I was with him and knew nothing was said. 
He continued in this state for several weeks ; finally be- 
came exhausted, had to take to his bed, where he remained 
several weeks. He had been removed to his father's farm, 
several miles distant, at this time, hence, not at this period 
under my observation. Now, being obliged to abstain, he 



170 THE CHLORAL HABIT. 

got better; but when he got better, relapsed into his old 
habit. Now, he was sent to Fort Hamilton, and there 
kept for, I think, six months. Perhaps a record of this 
case can be found there. 

' ' He returned here, and has been fully restored. Though 
after his sojourn in Fort Hamilton he had another attack 
of his appetite for chloral, whiskey, etc., which lasted some 
months. 

"His doses of chloral, daily, would amount to half an 
ounce, I estimate, for days together. The data are im- 
possible to learn, because he never kept it all in one bottle, 
and he had a supply located at various points, for conveni- 
ence. 

"The eruption did not itch. It lasted during the time 
of taking the drug, and subsided after it was discontinued. 
There was also, at times, a use of valerian, in quantities 
unknown." 

Dr. Roswell Park, of Chicago, 111., writes me of a young 
man "who established the chloral habit after a series of 
business reverses. He was nervous and excitable. I have 
no idea as to what amount he took. He finally developed 
a suicidal tendency, jumped from a fourth-story window, 
sustained a compound comminuted fracture of the elbow, 
and other injuries, and finally died, about the tenth day, 
from acute mania and exhaustion." 

Dr. James Bunting* had a patient who took large doses 
of chloral daily, with the effect of perverting the morals 
and producing a tendency to suicide. 

Dr. Thos. Bondt relates the case of a friend, a young 
medical man, who died of acute mania, produced by con- 
tinued and excessive use of chloral. 

The memory, especially for words, is greatly impaired. 

*Lancet, Dec, 1875. + Lancet, March 11, 1876. 



EFFECTS ON THE SYSTEMS. 171 

I have seen one case of this kind, and one such was re- 
ported to me by a medical gentleman in Boston, who forgot 
to sign his name to his very interesting letter. 

The patient whom I saw not only had an impaired memory 
for words, but would use one word for another, as "slip- 
pers" for "hat," or "pen" for "coat." He had been 
using the drug for nearly six years, and, although pro- 
foundly affected by it, would, at times, be decidedly better 
than at others. 

Dr. G. W. Davis, of Chico, California, writes me of the 
case of a lady who had been using the drug for some time. 
She first took it for facial neuralgia. She takes from forty 
to sixty grains daily. Her present health is fair. "She 
complains, however, of a fullness about the head, confusion 
of ideas, and loss of memory. ' ' 

Drs. Norton Folsom, of Boston, and J. W. Parsons,* of 
Portsmouth, N. H., relate cases where the habitual use of 
this drug produced childishness, fretfulness, muscular tre- 
mor, and, in Dr. Parsons' case, seemed to aggravate an 
existing attack of melancholia. 

Dr. James Perrigo,* of Montreal, relates the case of an 
old lady, sixty years of age, who took chloral, forty-five 
grains at bedtime, and fifteen grains during the day. She 
was partially insane, but whether from the chloral or not, 
I have been unable to learn. 

Maudsley* uses it but rarely in insanity. "Sometimes 
in melancholia. Rarely in mania, and then only when 
subacute." Similar testimony was obtained from Drs. 
Maudsley, Clouston and Lindsay, by the Committee of the 
London Clinical Society. 

Dr. A. P. Hayne, Medical Superintendent Inebriate 
Asylum, San Francisco, Cal., writes me: "There is no 

* Letters to the Author. 



172 THE CHLORAL HABIT. 

doubt but that its long continued use is one of the causes 
of insanity. I think I may safely say that several cases of 
this kind have fallen under my immediate observation, 
where chloral has been the remote or immediate cause of 
the disease." 

Dr. H. H. Doane,* of Litchfield, Ohio, reports a case 
where chloral produced, in an habitue, melancholia, with 
suicidal tendency. 

The following interesting case history was sent me by 
Dr. Frank R. Fry, of St. Louis, Mo. :— 

" Patient, J. M., aged fifty-nine years. First used chloral 
eleven years ago. At that time he had been having some 
domestic troubles, had been drinking some — he says, not 
hard \ he was unable to sleep, on account of these troubles 
and severe pains in the soles of his feet. His physician said 
they were not caused by rheumatism, but did not say by 
what. His physician prescribed him 15 grains of chloral 
in one ounce of water. Two teaspoonfuls of this solution, 
the prescribed dose, gave the patient some relief at first, 
but he immediately increased the dose to four teaspoonfuls. 
Does not remember exactly how soon, but very soon, he 
was taking from thirty-five to forty grains at a dose, every 
night, to obtain sleep. He increased the dose as fast as 
was necessary to obtain the continued desired effect, until 
he was taking eighty grains every night, and often a large 
dose during the daytime. 

Six years ago he was in the City Insane Asylum, for 
three months. When he left there he felt very much 
better, and states positively that he used no chloral for a 
period of three years after that time. 

He began the use of chloral again, subsequently, and for 
the last two and a half or three years he has been using it 

* Letter to the Author. 



EFFECTS ON- THE SYSTEMS. 17o 

very steadily and in large doses. He does not take such 
large doses at present, but takes it much oftener than he 
did. Says the size and frequency of the dose are much of 
the time varied according to his means. He does not 
now pay any attention to the number of grains he is taking, 
as he used to, but he has a hard time, often, in getting 
enough to satisfy. He is also drinking to some extent now. 
Says he has tried to substitute alcohol and morphine for 
chloral, but has always fallen back to the latter. 

He is now in bad health, suffers from dyspepsia and 
constipated bowels, and a generally debilitated condition. 
His father was a hard drinking man and his mother a very 
" nervous" person. 

Dr. C. Pollock,* of Donnelsville, Ohio, reports the case 
of a physician, aged fifty. From twenty to sixty grains 
were used nightly for two years, with the result of produc- 
ing loss of co-ordinating power, marked failure of memory, 
loquacity and intense despondency, and obstinate insom- 
nia, only relieved by continued taking of the drug that had 
caused all his misfortune, and which brought on only a 
troubled slumber, laden with dreams horrible beyond de- 
scription. The most prominent features of the case were 
his profound melancholia and extreme loquacity. 

A somewhat similar case is reported by Dr. T. D. 
Crothers,f Superintendent Walnut Hill Inebriate Asylum, 
Hartford, Conn., the case ending fatally. 

As in the opium and morphine habits, only more so, busi- 
ness is abandoned, friendship broken, family ties sundered, 
and unless relieved the victim sinks into a state of slobber- 
ing insanity or acute mania, finally ending in death through 
hemorrhage, exhaustion, or from the satisfaction of a sui- 

* Quoted by Mattison, "Chloral Inebriety," a paper read before the King's Co. 
Medical Society, April 15th, 1879. 
f Mattison, op. cit. 



174 THE CHLORAL HABIT. 

cidal tendency. Physical wrecks, guided by shattered men- 
tal rudders, they sink out of sight or go to pieces through 
accidents incident to their own self-produced restlessness. 
Thirty-eight of my correspondents report the production 
of insanity by the habitual use of this drug, as follows : — 

Acute mania, ..... 8 

Melancholia, . . . . . 16 

"Insanity/' . .... 3 

Silliness, childishness, etc., . . 11 

38 

In many cases where I wrote for more full and positive 
information I received no reply. 

THE NERVOUS SYSTEM. 

On the nervous system the effect of chloral, when habitu- 
ally used, is quite as decided and injurious as upon the 
mind. 

These symptoms may be classed as : — 

(a) Those affecting the nerves themselves. 

(£) Those affecting other organs, or systems, through 
the medium of the nervous apparatus supplying them. 

To the first class belong anaesthesia and hyperaesthesia, 
usually of parts of the body only. These may and do 
extend to the mucous, as well as to the cutaneous surfaces, 
as evidenced by gastralgia, loss of taste, incontinence 
and irritability of the bladder and sexual organs, etc., to 
be more fully considered a little further on. 

Neuralgic pains are felt here and there, more especially 
in the neighborhood of, but not in, the joints. Mattison* 
and others lay great stress upon this pain, which usually 
girdles the limb above or below the joint, as a diagnostic 
mark of the chloral habit. That it is not distinctive of 

*Op. cit., p. 5. 



EFFECTS ON THE SYSTEMS. 175 

this affection, and occurs in only a few cases, is proven by 
the fact that out of all the cases I have been able to collect, 
this symptom appears in but a few — nine — and in not all 
of these is the pain in the neighborhood of a joint. I 
have taken special pains to investigate this matter, for the 
value of a positive diagnostic sign in these affections cannot 
be underrated. In many of the cases, pains, resembling 
those of rheumatism or neuralgia, were present, but they 
did not girdle the limb or occur in the neighborhood of 
joints. 

Dr. Mattison says that Dr. Lee and others have ob- 
served these pains in the wrists and elsewhere. I find a 
case reported by Dr. Benj. Lee,* of a very nervous woman, 
who had taken chloral in twenty-grain doses, nightly, for 
eighteen months. Conjunctivitis occurred, the dose was 
reduced, and the eye trouble disappeared. She again in- 
creased the dose, when pains appeared in the wrists, 
rwining along the course of the radial arteries. The chloral 
was stopped and the pains disappeared. I find no refer- 
ence, in the place mentioned, to pain girdling the limbs. 
Unfortunately, Dr. Mattison makes no reference to the 
source of his information, so that it is impossible to say 
whether this is the Dr. Lee referred to or not.f Anstie, as 
quoted by Dr. Mattison, said that he was of the opinion 
that many cases of supposed rheumatic or neuralgic pains 
would be found, on careful investigation, to be due to 
chloral taking, and cited the following case, in which this 
symptom was prominent: — 

"A. B., physician, began the use of chloral Feb. i, 
1873, m thirty-grain doses, to produce sleep, when kept 

* Philadelphia Medical and Surgical Reporter, Nov. 9, 1878. 

f In a letter just received Dr. Mattison states that Dr. Benj. Lee, of Philadelphia, 
is the gentleman referred to, but that he (Dr. Mattison) does not remember in what 
journal he saw the case reported. 



176 THE CHLORAL HABIT. 

awake by great anxieties. In two months noticed in- 
flamed and weakened eyes, with scalding tears. Continued 
the drug, however, sometimes increasing the dose and 
repeating it. From April to August the usual amount was 
one drachm. In this latter month commenced using it 
during the day, one to three times. About Dec. ist, began 
to realize the amount he was daily taking, and found it 
half an ounce, sometimes more. He now began to com- 
plain of severe general pains, especially about the joints, 
which grew worse in the moist air of London. There was 
no tenderness, and they were not increased by motion. 
Chloral did not relieve them, except when it put him to 
sleep. Soon after this he made a mistake in his dose, 
using from a strong solution, which brought on the pains 
with frightful severity, and Dr. Anstie was summoned. 
He found him with suffused eyes, haggard features, sleep- 
less, peculiar, broken speech, lower extremities partially 
paralyzed, with loss of coordinating power, and excessive 
joint pains. An examination disclosed that he had taken 
more than an ounce of chloral the preceding day. It was 
at once withdrawn, cannabis Indica used to relieve the 
nervous disturbance, tonics ordered, and under this treat- 
ment he recovered." 

It is a well-known fact that rheumatism or rheumatic 
neuralgia, so called, is often aggravated by the administra- 
tion of acids. It is barely possible that in this case, the 
drug being kept in a solution, probably with syrup, 
partial decomposition may have taken place, and through 
the large amount of chloral taken, a sufficient amount of 
hydrochloric acid has been ingested to produce the 
aggravation of pain. I offer this simply as a suggestion. 
Many chloral-takers, especially the English, use the drug 
in the form of the officinal syrup chloralis (B. P.), or in 



EFFECTS ON THE SYSTEMS. 177 

a syrupy solution, expose it to the air and light, and do 
not keep it in warm places. When a large amount of the 
drug is used, and decomposition has taken place, an appre- 
ciable amount of acid might be taken. 

Pains in the limbs, face, chest, eyes, and about the heart 
are not uncommon, but in some cases never occur, although 
the person is taking large amounts (ioo to 200 grains). 

Flushing of the face and ears, and congestion of the 
eyes, the latter apparently bloodshot, is often seen, and is 
intensified by the use of a small amount of any alcoholic 
stimulant. A physician in the South, an habitue for years, 
writes me that his face became so very scarlet, and his 
eyes so bloodshot after drinking a glass of liquor, that 
people in the street would turn around and stare at him in 
amazement. It is of the same character, though less in- 
tense than that flushing of the face produced in some 
people, not chloral-takers, by the use of coffee. It is due 
to a more or less complete paralysis of the vaso-motor 
nerves. It is usually accompanied by dyspnoea and palpi- 
tation of the heart. It sometimes occurs on taking stimu- 
lants a week or ten days after the habit has been broken. 

Nervous chills are also often found, and following them is 
sometimes felt numbness of one leg or arm, or the sensa- 
tion of insects crawling on the skin of the trunk, less often 
of the limbs. 

Paralysis sometimes occurs, and is usually confined to 
the legs. Dr. W. R. Upham, of Yonkers, N. Y., reports 
the following: — 

"Had one case of a lady afflicted with cancer of the 
breast, who had taken about twenty-five to thirty grains, 
for one year. Soon after this she became partially para- 
lyzed in the lower extremities ; and, becoming very much 
frightened, she discontinued the use of the drug at once, 



178 THE CHLORAL HABIT. 

and without much trouble. She afterwards took up the 
use of morphine, and has recently died from the original 
disease. She was of a very nervous temperament." 

Here is a similar case by Dr. William Kirkpatrick Mur- 
phy*: — 

" Young man, twenty-nine years of age. Muscular ath- 
lete. Took chloral for insomnia. Amount taken not 
known, as it was taken loosely, without measure. Once 
nearly died from an overdose. Awoke one morning to 
find the power of his lower limbs completely gone. This 
was transient, but caused him to abandon the use of the 
drug. 

POINTS OF INTEREST. 

"i. The necessity often to use a large amount, in order 
to obtain any effect. When awakening, thirst, nausea, 
headache, irritability. 

"2. Well-marked erythema, intensified by stimulants. 
Palpitation very severe. 

"3. Acute pains in lower limbs, especially calves of 
legs. Some loss and perversion of sensibility in feet and 
legs in morning. 

" 4. Inability to use legs. Passed off in one day, leaving 
patient physically and mentally weak. ' ' 

Brown-Sequardf relates "two cases of mania, with ob- 
stinate insomnia, in which he gave five grains twice a day to 
one and double that to the other, followed by thirty to forty 
grains at night. After seven or eight weeks of this treat- 
ment the patients had become so feeble as to be unable to 
walk or to put one foot before the other. This rapidly 
disappeared when the chloral was withdrawn." 

Anstie (also quoted by Dr. Mattison), with his charac- 
teristic honesty, relates the following : — 

* London Lancet, Aug. 9, 1873. f Quoted by Mattison, op. cit., p. 5. 



EFFECTS ON THE SYSTEMS. 179 

" He was called in consultation, to a lady, aged thirty- 
eight years, with symptoms of partial paraplegia, of obscure 
origin. Reflex uterine irritation was mentioned as a 
cause, but the suggestion was not accepted. The regular 
medical attendant then suggested that the nightly doses of 
chloral, which the patient had for some time been taking, 
to procure sleep and allay mental anxiety, might be a 
factor in the paralytic trouble. This was also rejected, 
and, as some sedative seemed called for, the chloral was 
continued. The lady, however, failed to improve from 
the treatment recommended, and, after one or two con- 
sultations, a different physician was called. He accepted 
the chloral hypothesis, the sleeping draught was discon- 
tinued, and she speedily lost her paraplegia. Anstie 
observed that the case afforded him some practical but 
rather rueful reflections." 

Dr. Mattison says: "The loss of power in the lower 
extremities is sometimes very marked, and strongly sug- 
gestive of serious spinal lesion." It would seem, from the 
rapidity with which the trouble disappears on the discon- 
tinuance of the drug, and its sudden appearance in some 
cases, to be due, more likely, to derangement of the circu- 
lation in the cord, dependent on vaso-motor paralysis. 

Vertigo, trembling of the hands and body, and "ina- 
bility to # stand erect, with tendency to fall forward, as in 
ataxic trouble, lack of coordinating power, so as to be 
unable to write, whistle, button clothing, etc." (Mattison), 
are often seen. The tongue, when protruded, trembles ; 
paralysis of one side of the face and ptosis sometimes occur. 
Flashes of heat, followed by a cold sweat, on stumbling, 
"stubbing" the toe, or without any appreciable cause, is 
often noticeable. 



180 THE CHLORAL HABIT. 



CHAPTER X. 

EFFECTS OF CHLORAL ON THE DIFFERENT SYSTEMS AND 
APPARATUSES. 

THE DIGESTIVE APPARATUS. 

The effect of chloral upon the organs of digestion is 
twofold. (a). That due to its local action, and (£) its 
effects produced through the medium of the nerves sup- 
plying the parts. Taking the throat first, we find that 
there is usually more or less irritation and congestion from 
the local action of the drug. In some cases there is 
paralysis of the muscles of deglutition. Dr. J. H. Arton, 
of Hamilton, Bermuda, writes me that in one case chloral, 
no matter how given, always produced irritation of the 
throat and difficulty in swallowing. No other drugs were 
being given at that time. It disappeared on stopping the 
chloral. This patient was not an habitual user of the 
drug. It only produced this effect when the drug was 
given in large quantity, or often. 

Dr. R. C. Brandeis* relates the case of a lady who was 
an habitual user of chloral. For some nine months she 
had been taking from forty to sixty grains, three or four 
times a day. It produced great difficulty in swallowing, 
intense hypersemia of the pharynx and larynx, and the 
return of fluid through the nostrils. There was occlu- 
sion of the oesophagus and paralysis of the muscles of the 
larynx. She fully recovered on strychnia, iron and 
quinine, finally stopping the chloral. The curious fact 
has been noted by some of my correspondents, that a 

* American Practitioner , 1875. 



EFFECTS ON THE SYSTEMS. 181 

rectal injection of chloral will, in some patients, im- 
mediately produce a peculiar sensation in the throat and 
a metallic taste in the mouth. 

" Dyspepsia ' ' is one of the earliest symptoms complained 
of by these patients. From simple loss of appetite to the 
gravest forms of gastric trouble may be produced. There 
is loss of sensitiveness, alternating with the most severe 
gastric pain. The tongue is coated, the breath foul, and 
not having the odor of chloroform. Circulation in the 
liver is disordered, gastro-duodenal catarrh results, with 
accompanying jaundice, that is sometimes intense. A sense 
of fullness and pain over the hepatic region is not un- 
common. Small, brownish patches upon the skin, known 
to the laity as " liver spots," are frequently seen. The 
bowels are constipated, the stools lacking in bile, and, 
consequently, clay colored, hard, and sometimes coated 
with mucus, here and there streaked with blood. Hemor- 
rhage from the bowels and stomach sometimes occurs. 
Diarrhoea alternates with constipation. 

Some patients, taking the drug in large amounts and for 
a considerable time, are not troubled at all with affections 
of the digestive organs. 

An habitue, a physician in the South, assured me that 
it always increased his appetite when taken before meals, 
and Dr. A. P. Hayne, of San Francisco, says that he has 
seen a number of these cases, in which there was no effect 
on these organs beyond a temporary stimulation. 

THE URINARY ORGANS. 

Upon the kidneys the effect of the long continued use 
of chloral is to produce congestion, dilatation of the 
vessels, and albuminuria. There is no positive evidence 
that chloral produces any organic change in these organs. 



182 THE CHLORAL HABIT. 

Albumen is present in the urine, often in large amount, 
but its presence there is readily accounted for by the vaso- 
motor paralysis, and the impoverished condition of the 
blood, which is still further aggravated by this, its symp- 
tom. Casts are often found, but are usually small and 
medium sized light granular, and hyaline. Epithelial 
and fatty casts occasionally occur, but it is probable that, 
in these cases, renal disease had commenced before the 
chloral was used to excess. Hemorrhage from the kidneys 
and, indeed, from the whole urinary tract, is sometimes 
found. It is but a part of a general condition, usually, 
purpuric spots being found on the skin, and bleeding oc- 
curring from the mucous membrane of the throat, stomach, 
nose, or bowels. 

Both before the albuminuria appears, and during its 
continuance, dropsy is not uncommon. Puffiness of the 
face and eyelids, dropsy of the feet and legs, and ascites 
occur in certain cases, not from suppression of urine, but 
from the condition of the vascular system and blood. 

The albuminuria, unlike that of opium patients, is usually 
persistent. 

Diabetes is found in some cases where large amounts of 
the drug have been used for a long time. In acute poison- 
ing by this drug sugar has been found in the urine of man, 
by Bouchut* and Levensteinf. LabbeeJ failed to find it 
in the urine of chloralized rabbits and frogs, but Feltz and 
Ritter§ found it in the urine of dogs into whose veins they 
had injected chloral. They proved its presence by both 
the fermentation and reduction tests. They also claim to 
have found an organic body, which was present in such 

* Quoted by Labbee, Archiv. Gen. de Med., 1870, p. 330. 
f Berlin Klin. Wochen., July 3, 1876, p. 389. 
% Archiv. Gen. de Med., tSjo. T. 2, p. 330. 
g Compte Rendu, Aug. 3, 1874. 



\ 

EFFECTS ON THE SYSTEMS. 183 

small quantity that a determinative analysis was impos- 
sible. The same substance was probably found by Von 
Mering and Musculus, who named it uro-chloralic acid. 
They found that it reduced the copper and bismuth tests, 
and turned the polarization apparatus to the left. This 
from small doses, while large doses gave sugar, turning the 
polarization apparatus to the right. 

Dr. John B. Roberts and Morris J. Lewis* found that 
the urine of patients taking chloral, and urine to which 
chloral had been added, gave a yellow precipitate, with 
Fehling's test solution. 

It is probable that in the urine of patients habitually using 
small doses of chloral, the reaction with the copper solu- 
tion is due to the presence of uro-chloralic acid, while 
that of those taking large doses is due to both uro-chloralic 
acid and sugar; the preponderance of the latter masking 
or overcoming the reaction of the former, especially with 
the polarization test. 

The functional activity of the kidneys varies greatly from 
day to day. At times the urine is very scanty and high 
colored, at others, passed in quantity and of a light straw 
color. Unlike the urine of opium takers, the gravity 
varies markedly from day to day (1.006 to 1.045). 

On the mucous surface of the bladder and urethra the 
continued use of this drug sometimes produces decided 
irritation, and often congestion. Frequent desire to urinate, 
burning and cutting pain in the act, and a sensation as 
if the contents of the bladder had not been fully evacuated, 
are often found, more especially in women. 

It has an action, also, on the muscular structure of the 
viscus, producing temporary paralysis, with retention. 

Oxalate of lime, and numerous fibrillse of mucus, occur as 

* A7nerican Journal of the Med. Sciences, Oct., 1877. 



/ 

184 THE CHLORAL HABIT. 

deposits. The reaction varies from intensely acid to dis- 
tinctly alkaline. 

Deposits of stellar phosphates are of frequent occurrence. 

My correspondents report as follows: — 

Irritability of the bladder, with tenesmus, 21 instances. 
Hemorrhage from the urinary organs, 6 

Retention of urine, . . . .11 
"Atony" and paralysis, . . . 7 

Albuminuria, . . . . .23 

Reduction of copper test, . . 16 

Casts in urine, ..... 7 

SEXUAL ORGANS. 

The evidence as to the effect of the continued use of 
chloral on the sexual apparatus is meagre and conflicting. 
The sexual appetite seems to be at first decidedly 
increased, but finally greatly impaired or lost. Such an 
increase was observed in one case by Dr. J. A. Miller, of 
Williamsburg, Ky. (non-habitue). I have seen a decided 
increase in two cases from occasional small doses, where 
the effect could have been due to nothing but the chloral ; 
and in one case, by Dr. John N. Upshur,* where it had 
been used for weeks, with large doses of the bromides, in 
a case of tetanus in a negro. 

On the other hand, Dr. Edward Bradley, of this city, 
writes me that in ten cases he has found decided decrease 
in sexual appetite and inability to have an erection in 
patients taking chloral for a short time. It disappeared 
shortly after stopping the chloral. Dr. J. W. F. Webb,f 
of Liberty, Miss., has known it to diminish and tempo- 
rarily destroy the sexual appetite, when taken only for a 
few days. Also in the case of a chloral eater. 

Dr. Horatio C. Bigelow,f of Washington, D. C, saw 

* Virginia Medical Monthly, May, 1880. f Letter to the Author. 



EFFECTS ON THE SYSTEMS. 185 

"loss of erectile power follow the use for one month of 
ten grains of the drug, three times daily." The person 
was a strong, healthy man, seemingly of good virile power, 
to whom it had been given for chronic dysentery. He was 
never so affected before. It was some months before there 
was any return of power. 

Dr. J. H. Nordlin,* of Rome, Ga., has used it success- 
fully as an anaphrodisiac, as also a correspondent of the 
Lancet.\ Dr. O. F. Ham, of North Barnstead, N. H., writes 
me of a chloral taker, a lady, whom he has questioned 
closely. She avers that chloral has absolutely no effect on 
her sexual appetite, which was never marked. 

Sensitiveness of the organs of generation, a kind of 
mucous membrane hypersesthesia, has also been noted by 
Dr. H. H. Doane,* of Litchfield, Ohio, as follows: — 

"Female, aged forty-two ; used chloral for twelve years. 
Given for insomnia and nervousness of prolapsus uteri, 
with constipation. Bilious temperament. Dose, twenty 
grains, four or five times a day. Present condition, pro- 
lapsus uteri, obstinate constipation, great loss of flesh and 
muscular power, appetite poor, stomach weak and tender 
on pressure; also constant, dull, and sometimes sharp 
gastric pain. Headache, nervous prostration, loss of mind 
(general melancholia, with suicidal tendency, if chloral is 
withdrawn for a few days). No pain in neighborhood of 
joints, slight dimness of vision accompanying headache. 
No family history of morphine or opium habit or alcohol- 
ism. Extreme sensitiveness of sexual organs. ' ' 

Its effect on menstruation is slight. It sometimes causes 
too free flow, sometimes a slight, continuous flow. I can 
find no facts supporting the belief that it, like morphine 
or opium, produces sterility. As menstruation seems to be 
unaffected it is probable that it does not do so. 

* Letter to the Author. f June, 1871. 



186 THE CHLORAL -HABIT. 

As bearing upon the effect of chloral on menstruation, 
the following letter is of interest. No replies seem to have 
been received. 

To the Editor of the Lancet : — 

Sir — Have any of your correspondents noticed one 
peculiarity in the action of hydrate of chloral — namely, 
its power entirely to check the catamenial discharge ? I 
have three patients who are in the habit of taking the drug, 
for attacks of asthma, and who have assured me that its 
exhibition is attended with this one drawback, if taken at 
the onset of the monthly period. I have had no oppor- 
tunity of verifying their statements, but imagine there must 
be some truth in them, as they are all three of them in 
different stations of life, do not know one another, and 
cannot have compared notes. Moreover, their statements 
were volunteered, and not elicited by leading questions. 
Your obedient servant, G. H. R. Dabbs, m.d. 

Newport, L W., Sept. 21st, 1872. 

CIRCULATION AND COMPOSITION OF THE BLOOD. 

Aberrations in circulation are due to derangement of 
the nerves governing the vessels ; in other words, the 
vaso -motor system. 

Flushing of the face, fullness of the head, redness of the 
ears, congestion of the eyes, alternating hyperemia and 
anaemia of the various organs, is the result. From this 
cause we have the intense splitting headache one day, 
vertigo the next. 

Palpitation of the heart, a weak, intermittent, irregular 
pulse, cough due to lung hyperaemia, accompanied by ex- 
cess of secretion, often follow. Heart murmurs are some- 
times heard, chiefly in very anaemic patients. Palpitation 



EFFECTS ON THE SYSTEMS. 187 

and irregular action of the heart is due to three causes, in 
the majority of cases — irregular nerve supply, impoverished 
blood, and atony of the cardiac muscles. This is not so in 
all cases, for we sometimes get these same symptoms from 
single doses of chloral, referable wholly then, I think, to 
disturbed nerve supply. 

Upon the blood itself chloral acts as a disorganizer. 
That it does so we know. How it does so it is impossible 
to tell. This deterioration is evidenced by its action on 
the skin, to be noticed fully further on ; by the tendency 
to hemorrhage from mucous membranes, purpuric spots 
beneath the skin, spongy gums, falling of the hair, loss of 
the finger and toe-nails, malnutrition of the muscles, brain, 
and nervous system, anaemia, dropsy, and the but too pal- 
pable evidences of a general breaking up of the whole 
system. 

Ludwig Kirn,* who has contributed some very valuable 
observations on the long continued use of chloral, relates 
the following : — 

"We come now to a fourth group of cases, in which 
both the quality of the symptoms and their greater or less 
extension in the organism indicate a distinct change in 
the composition of the blood. 

" In this connection, the following cases, observed by 
Crichton Browne^ may first be referred to ; their interesting 
phenomena justify a detailed report. 

"Case i. — A woman, aged sixty-nine years, suffering 
from periodical mania, had twenty, grains of chloral twice 
daily ; on the fourth day a redness was developed on the 
skin of the chest and shoulders, which did not vanish on 
pressure ; on the sixth day the eruption had extended over 
the whole- trunk and limbs, livid spots and deep-red 

* Practitioner, 1873. 



188 THE CHLORAL HABIT. 

patches alternating. The lips and the mucous membrane 
of the mouth were excoriated, the gums spongy, the tongue 
blistered and ulcerated, the breath foetid. The general 
state was one of great depression; pulse 120. On the 
eleventh day the ulceration of the mouth had extended 
further ; the lips were covered with crusts. The petechial 
eruption was diminished on the chest and abdomen \ the 
spots were yellowish, with patches of white skin between 
them ; the spots on the arm lost their redness later. On 
the fifteenth day there was a sort of general desquamation ; 
fissures of the skin over the sacrum and in the neighbor- 
hood of the joints. From that time convalescence proceeded 
and ordinary health was restored. 

" Case 2. — A woman, aged forty-six years, suffering 
from cardiac disease, hemiplegia, and dementia, took 
fifteen grains of chloral, three times a day, with calming 
effect. On the nineteenth day of the treatment numerous 
purple-red spots appeared in the neighborhood of the left 
elbow ; on the next day many similar spots were seen on 
the shoulders and forearms, which coalesced with the 
others. On the twenty-first day livid spots came on the 
face; the left arm swelled and became hard. On its sur- 
face appeared a multitude of minute points, of a much 
deeper color, which did not diminish on pressure. Next 
day there were dark purple spots and discolorations ; some 
small, round, and circumscribed ; others broad and irregu- 
larly shaped, on the legs and abdomen, and in stripes on 
either side of the vertebral column. Simultaneously with 
the petechia there was great prostration, tendency to som- 
nolence, weakness and excitability of the pulse, sore lips, 
thickly coated tongue. On the twenty-third day the spots 
and discolored patches had extended in every direction, 
and the previously bright-red spots had assumed a deep- 



EFFECTS ON THE SYSTEMS. 189 

purple color. Finally, signs of lung congestion appeared, 
with gradual failure of power, and death, after several 
fainting fits, on the twenty-sixth day. At the autopsy 
numerous ecchymoses, of every shape and size, were ob- 
served, more or less, on all parts of the skin \ the right 
lung was congested and cedematous ; the heart dilated and 
its valves thickened ; over the right central hemisphere 
there was a large arachnoid cyst, containing fluid blood. 

"With the foregoing may be joined a case, related by 
Monkton, in which, after four days' administration of 
sixty grains of chloral daily, a rash resembling slight 
variola, with hemorrhagic purpura, appeared, and death 
occurred on the sixth day, by syncope. 

"Finally, may be mentioned two patients of Pelman, in 
whom, after treatment with chloral, there were larger and 
smaller petechia over the whole skin ; in one which proved 
fatal numerous petechia were found on the mucous mem- 
brane of the larynx and under the endocardium, and a 
hsematoma on the right side in the skull, reaching to the 
base, the fluid contents of which gave evidence of their 
recent origin. 

"I shall now relate a case observed by myself, which is 
yet more striking, from the multiplicity of its phenomena, 
which are of a kind, perhaps, to give us some clearer under- 
standing of their origin. The case was observed by me at 
a time when the evil effects of chloral hydrate were not 
yet known; the medicine was, therefore, continued, in 
spite of the most multiplied symptoms, because chloral 
was not for a long time recognized as their cause; the 
affection was, therefore, followed up further than we should 
dare to do now, that our increased knowledge would oblige 
us to stop at an earlier stage. [Here follows a detailed 
report of the case, which need not be given]. If we may 



190 THE CHLORAL HABIT. 

sum up the weightier symptoms of this case, we find a 
young, strong, personally healthy person suffering from 
uncomplicated mania, in whom, on the ninth day of 
chloral treatment, a rash appeared in the form of groups 
of red spots, which soon became confluent. On the 
twentieth day the temperature and pulse rapidly rose to a 
febrile pitch ; three days later the temperature had reached 
106.7 ; large and repeated doses of quinine were given 
without result, and baths had only a temporary effect. 
(Edematous swelling of the face, cheeks, eyelids and ears 
now set in. During the whole course of the disease the 
skin, so far from returning to its natural appearance, was the 
seat, now of impetiginous, now of moist, now of scaly eczema 
and ichthyoses, so thatthe process of desquamation, instead 
of being short, as in the acute exanthemata, occupied many 
weeks, during which great sheaths of epidermis were cast 
off from all parts of the body. 

i 'The profound lesions of the skin nutrition were evidenced 
in the later stages by a remarkable shedding of the hair, 
and a gradual falling off of all the nails of the hands and 
feet. The affection of the skin was accompanied by a 
similar one of the mucous membranes, first of the intes- 
tines, which kept up watery diarrhoea in spite of medicine, 
and then by a similar affection of the conjunctiva and the 
bronchi. From the sixth week of the disease onward a 
series of large abscesses formed on both arms, over the 
shoulders and armpits, which secreted a considerable quan- 
tity of pus. While these phenomena were occurring there 
had been for eight weeks a continuous fever, occasionally 
remitting, and then again running up to a temperature 
beyond 104 . 

"The symptoms which we have now collectively de- 
scribed must be defined as chronic blood poisoning. We 



EFFECTS ON THE SYSTEMS. 191 

cannot, however, place this in any of the known groups; 
we have not to do with a pyaemia or septicaemia, nor with a 
metallic or vegetable poisoning, since none of the causes 
have been at work which would lead to these affections, 
nor do we observe their characteristic phenomena ; still 
less did the affection which the medicine produced in this 
patient resemble puerperal mania. In fact, there was no 
other external cause except the administration of the 
chloral ; this medicine, which in even much larger single 
dose produces no such effect, was for ten w T eeks given in 
nightly doses of forty to sixty or even seventy-five grains ; 
sometimes in two doses daily. The symptoms began after 
a certain saturation had been produced by accumulation, 
to spread further and further, and finally to assume the 
complete picture of a chronic blood poisoning. 

" The origin of the disease leads us thus, by exclusion, to 
conclusions which have a high degree of probability, and 
we are also in a position to adduce positive facts. If a 
glance be cast at the symptoms observed by ourselves and 
others, after a more or less continued administration of 
chloral, we meet with the greater part of the phenomena 
observed in our last case, especially the very various affec- 
tions of the skin and mucous membranes, the alterations 
in vascular action, and finally, the profound alterations of 
the blood, which in some cases remind us of the phenomena 
of scurvy." 

The characteristic feature in the morbid picture which 
we have given consists less in symptoms which in them- 
selves are altogether new, than in the assemblage of the 
most heterogenous phenomena, which previously had only 
been observed singly, in one person, and in a most aggra- 
vated degree of intensity. 

It is a peculiar fact, that such severe symptoms as are 



192 THE CHLORAL HABIT. 

here related, comparatively common in the early history 
of the drug, are not now seen, save in very rare instances, 
even in persons using larger quantities of the drug for a 
much longer time. There must have been some impurity 
in the drug as then used. It might be supposed, also, 
that such effects would be more apt to occur in these 
insane patients, much below par mentally and physically, 
was it not well established that its prolonged use in like 
cases, at the present day, does not produce the same effects, 
save in occasional instances.* The ulceration of the skin 
about the finger and toe-nails, spoken of by so many ob- 
servers. Thus, Professor Nathan R. Smith, of Baltimore, f 
reports two cases where this occurred. Twenty -six similar 
cases have been observed by Dr. James G. Kiernan,f 
former Assistant Physician at the New York City Asylum 
for the Insane. 

From eighteen superintendents of insane and five phy- 
sicians of inebriate asylums, from whom I have heard, not 
one mentions this condition of skin about the edges of the 
nails. The only case of the kind reported to me is by Dr. 
J. W. F. Webb, of Liberty, Miss., and consisted in simple 
elevation of the skin at these points, without ulceration. 

I think we must conclude that there was some impurity 
of the drug used, although Dr. Kiernan avers that the 
drug was that furnished by Powers & Weightman. 

Disordered condition of the blood manifests itself in 
other skin affections. Judging from its effects in single or 
small doses in certain persons who manifest an idiosyn- 
crasy, would lead us to entertain the possibility of skin 
affections from the long continued use of the drug. An 
artificial idiosyncrasy seems to be developed. 

* Kane; " Chloral Hydrate in the Treatment of the Insomnia of Insanity and 
Delirium Tremens." N. Y. Medical Record, Jan. 8 and 15, 1881. 
f Quoted by Mattison. Op. cit. 



EFFECTS ON THE SYSTEMS. [93 

Single doses, or the use of moderate doses for a short 
time, has been found to produce erythema, eczema, papu- 
lar, pustular, or macular eruptions ; also urticaria and 
herpes zoster. In a few well-authenticated instances, erup- 
tions, exactly resembling and in some cases mistaken for 
those of measles and scarlatina, have been produced. They 
passed through regular gradations, finishing with the 
typical desquamation of the disease simulated. Further 
use of the chloral again produced the same disturbances.* 
It has been suggested that these effects are due to disorders 
of the digestion, as excessive acidity, etc., produced by 
chloral. This is disproved by the fact that in the majority 
of instances where they occur, the digestive organs are not 
disturbed. 

Schulef believes that the majority of these skin affec- 
tions are due to nervous disturbance. 

The following cases of hemorrhage are of interest in this 
connection : — 

Dr. A. E. M. Rae (Edinburgh Medical Journal, Nov., 
1 871) relates a case of hysteria, where he gave chloral for 
months. Bleeding from the lungs became so frequent and 
violent that twice the patient's life was despaired of, and 
he had to abandon the use of the drug entirely. He refers 
also to a case by Dr. Husband, where fatal hemorrhage 

* Kane ; "Some Peculiar Effects of Chloral Hydrate on the Eyes and Skin." 
N. Y. Medical Record, 1881. 

To those interested in the further study of the action of chloral on the skin, I give 
the following references : — 

Browne, Crichton, Lancet, Vol. 1, p. 440. Curschmann, Deutsches Archiv f. 
Klin. Med., 1871, p. 139. Brochin, M., Bull. Gen. de Therap., Feb. 15, 1880. 
Burman, J. Wilkie, Lancet, Mar. 16, 1872. Farquharson, Braithwaite' s Epitome, 
Mar., 1880. Ingalls, Wm., N. Y. Medical Record, 1871, p. 91. Liebreich, O., 
Lancet, June 16, 1877. Mayer, La France Medicale, 1876. Martinet, These de 
Paris, 1879. Neal, Breward, Lancet, Aug. 23, 1873. Smith, Nathan R., N. Y. 
Medical Record, 1871, p. 299. Kiernan, J. G. ; Quoted by Mattison. Op. cit. 

f Allgemeine Zeitschrift f. Psychiatrie, Bd. 28, Heft. 1. 
13 



194 THE CHLORAL HABIT. 

from a fibrous tumor of the womb occurred in a patient 
who was taking chloral. Spencer Wells {Medical Times 
and Gazette, Sept. 18, 1869) has, however, given it in 
cases of cancer of the womb, without producing bleeding. 
Turnbull (Philadelphia Medical and Surgical Reporter, 
Aug. 31st, 1872) claims that it increases the menstrual 
flow. Dr. C. R. Cullen, of Richmond, Va., writes me 
that he has seen flooding follow its use. R. C. Shettle, 
Physician to the Royal Berkshire Hospital, believes that its 
use is dangerous in labor cases, owing to the likelihood of 
flooding afterwards. This is totally disproved by a mass 
of testimony sent me by my correspondents.* 

Bleeding from the nose has been noted by Inglis (Edin- 
burgh Medical Journal, Sept., 1877), by Mauriac, in three 
cases {Gazette des Hopitaux, 1870, p. 405) and Dr. F. 
Delmont, of San Buena Ventura, Cal. (by letter). This 
was a hysterical lady, who was using large quantities of 
chloral. After one of her spasms about an ounce of blood 
flowed from her mouth in a fine stream, as though thrown 
by a syringe. 

MUSCULAR SYSTEM. 

Upon this system the effects are decided, and are chiefly 
produced through the agency of the nervous system. f 
Trembling, spasm of isolated muscles and muscular fibres, 
convulsions, paralysis, loss of coordinative power, etc., 
have already been spoken of. 

Certain symptoms, as flabbiness, paleness, atrophy and 
weakness, result from imperfect nutrition. By confining 

* Kane, "Chloral in Obstetric Practice." America?i Journal of Obstetrics, 
March, 1881. 

f This is conclusively proved by the experiments of both Labb£e and Rajewsky, 
quoted by H. C Wood, u Materia Medica and Therapeutics," Philadelphia, 1877, p. 
318, 319. 



EFFECTS ON THE SYSTEMS. 195 

these patients to the house a great deal it still further 
lowers the tone of the general health. 

RESPIRATION. 

This vital function is very seriously affected in certain 
advanced cases. Dyspnoea is the most prominent symp- 
tom. This is more marked if alcoholic stimulants are 
taken. The trouble is undoubtedly of purely nervous 
origin. It is usually accompanied by a slight cough, and 
excessive secretion of mucus. Ludwig Kirn * says : — 

"An important symptom which we have noticed in a 
series of cases of the long continued use of chloral is an 
interference with respiration, which may remain slight and 
scarcely troublesome to the patient, or may become posi- 
tive dyspnoea. 

" This symptom was experimentally produced by the 
Swede, Hammersten, who observed severe dyspnoea in a cat 
that had taken chloral, and was briefly noticed by Jastrowitz, 
one of whose patients, while taking chloral, suffered from 
severe dyspnoea, with occasional cessation of breathing ; 
and it was finally completely described and explained by 
Schule, who observed a patient who, after a long use of 
chloral, used regularly to suffer after meals from a sense of 
oppression, which made going up stairs extremely difficult, 
and even interfered with speech, although there was no 
chest disease to account for this. The symptoms persist- 
ently recurred in spite of all treatment, until the chloral 
was left off, when the oppression entirely disappeared. A 
similar chloral dyspnoea, though not so long continued, 
occurred in many cases observed by us, either with or 
without a rash, and a feeling of heaviness and anxiety. 
That the chloral dyspnoea does not always stop at the lower 

* Practitioner , 1873. 



196 THE CHLORAL HABIT. 

degrees, but may proceed to the most severe and dangerous 
developments, is shown by the following observation com- 
municated to me by an eminent physician. This gentle- 
man was summoned in consultation by a lady prostrated 
by long suffering, who had of late suffered from attacks 
of extreme dyspnoea, which had increased to asphyxia. 
At the same time the face was swollen, the facial muscles 
paralyzed, and there were also all the signs of cerebral 
effusion. 

"Every remedy had failed, and the patient seemed on 
the brink of the grave. The physician, therefore, recom- 
mended the discontinuance of a daily dose of forty-five 
grains of chloral which had been given as an hypnotic, 
whereupon all these highly alarming symptoms vanished, 
in an almost magical way ; the cerebral disturbance ceased, 
and the respiration quickly resumed its normal type. The 
dyspnoea may be anatomically explained by analogy with 
the effects of chloral upon the skin and mucous membrane, 
by hyperaemia of the lungs, which is produced through the 
channel of the vaso-motor nerves. 

"We find here a further confirmation of the assumption 
that chloral operates upon the vaso-motor centre and the 
medulla oblongata, and that its paralyzing influence extends 
thence to the peripheral branches of the affected nerves. 
This might also lead to a practical contra-indication of 
chloral in all morbid conditions where there is a tendency 
to congestions or stases of blood in the lungs. ' ' 

In non-habitues it has been found by Fothergill* to pro- 
duce dyspnoea where there is cardiac disease: — 

"A patient was taken into the West London Hospital, 
with emphysema and aortic stenosis. In spite of rest, 
digitalis and ammonia, he was liable to attacks of dyspnoea, 

* "Antagonism of Therapeutic Agents/' p. 54. 



EFFECTS ON THE SYSTEMS. 11)7 

which had come on since his admission into the hospital. 
On searching for an explanation, it was found that the 
house-surgeon had benevolently prescribed chloral for the 
sleeplessness complained of. This was at once stopped, 
and the attacks of dyspnoea never returned, though the 
man gradually sank." 

Dyspnoea is reported by thirteen of my correspondents 
as a symptom of the continued use of chloral. 

On the throat and larynx the effect is one of decided 
irritation, attended by congestion and sometimes ulcera- 
tion. The uvula is congested and ©edematous, the epiglottis 
red and swollen, and the vocal cords sometimes congested 
also. Cases of this kind are reported by Kirn* and Chap- 
man -j". 

THE EYES. 

Upon the eyes the continued use of chloral produces a 
very decided and characteristic effect. Some persons not 
addicted to the use of chloral manifest a peculiar idio- 
syncrasy with reference to it. A single dose sometimes, 
more often a few doses, will produce severe conjunctivitis, 
occasionally accompanied by oedema of the subjacent 
parts, as also of the face. Photophobia is often marked. 
Abundant testimony as to this effect of chloral on the eyes 
may be found in my article upon that subject in the N. Y. 
Medical Record for 1 88 1 . 

Conjunctivitis from the continued use of chloral is re- 
ported by forty-one of my correspondents, oedema by thir- 
teen, and photophobia by thirteen. 

Sixteen report "weakness of vision," nine report "double 
sight," one cataract, one sudden blindness disappearing 
on discontinuance of the drug, one ptosis, four amblyopia, 
and six asthenopia. Two cases of temporary blindness 

* Op. cit. f Lancet, 1871. 



198 THE CHLORAL HABIT. 

from chloral are also reported. This was in non-habitues. 
Keyser,* of Philadelphia, reported the case of a gentleman 
accustomed to sixty and eighty grain doses of chloral, who 
suddenly became blind. Opthalmoscopic examination 
revealed great retinal anaemia. The drug was discontinued, 
and in a few days sight was restored. 

Schulef demonstrated that in chloral takers the retina was 
congested. The same condition was observed by Bouchut J 
in the retina of children completely anaesthetized. 

Burke Haywood, § of North Carolina, observed an elderly 
man, who, after some weeks' use of chloral, began to 
complain of dimmed vision, which persisted and increased 
till the drug was withdrawn, when it gradually disap- 
peared. 

The case of ptosis is reported by Dr. H. C. Bigelow, of 
Washington, D. C, as follows: — 

"Female, aged thirty years, married, spare build, ner- 
vous temperament, and active mind. Grains thirty to 
sixty, daily, for eighteen months. Emaciated, hysterical, 
constipated, flatulent. Temper irritable. Ptosis of the 
right eye, commencing iritis and photophobia. Ulcera- 
tion of os uteri. Had an orgasm while being examined. 
Vaginismus ; sexual appetite strong, but dislikes her hus- 
band and marital intercourse. Suffers from insomnia, loss 
of memory, mental unsteadiness. She ascribes all these 
symptoms to chloral." 

Dr. N. C. Husted, of Tarrytown, N. Y., reports to me 
the case of a lady who has used the drug in from ten to 
twenty-grain doses, for about eighteen months. She is 
troubled with partial amaurosis and excessive lachrymation. 

* Quoted by Mattison. Op. cit. 

f Allgemenie Zeitschrift f. Psychiatrie , Bd. 28, Heft 1. 

J Quoted by Labbee, Bull, Gen. de Therafi., 1869. T. 2, p. 758. 

§ Quoted by Mattison. Op. cit. 



EFFECTS ON THE SYSTEMS. 199 

Dr. Edward Bradley, of this city, reports to me the case 
of a lady who took twenty grains of chloral, three times a 
day, for some time. Eyesight gradually failed, and she 
was soon obliged to wear glasses. Her eyes were thor- 
oughly examined, and nothing abnormal was found. On 
discontinuing the chloral the eye trouble speedily disap- 
peared. The effects of the drug on the general system, 
especially the digestive apparatus, was very marked. The 
habit was broken without trouble. 

For a full discussion of the subject here presented in 
outline, the reader is referred to my article in the Record, 
already spoken of. 



200 THE CHLORAL HABIT. 



CHAPTER XI. 

SYMPTOMS OF ABSTINENCE FROM CHLORAL DOSES AND 

DANGERS TREATMENT. 

The symptoms incident to the abrupt withdrawal of 
chloral from those who have used it for a long time are 
rarely severe; never so severe as those attending the same 
procedure in opium or morphine habitues. Many chloral 
takers voluntarily intermit the use of the drug for weeks at 
a time, themselves. 

One of the most prominent symptoms that occurs occa- 
sionally is the supervention of severe delirium, very like 
that of delirium tremens. Such a case is reported by Dr. 
Geo. F. Elliot/*' The patient, a man, aged thirty-five 
years, had, however, taken fifteen grains of opium, daily, 
for many years. He had for a few weeks substituted 
chloral, taking 200 grains of this drug daily. On with- 
drawing the chloral all the phenomena of delirium tremens 
appeared. It subsided on the use of large doses of tartar 
emetic and opium. Similar symptoms are reported by 
many of my correspondents. 

Flashes of heat, nervous prostration, palpitation of the 
heart, dyspnoea, insomnia, sometimes persistent, intense 
headache with vertigo, and neuralgic pains in the occipital 
region, are likewise common. 

Pains in the limbs are usually found, but are not so 
severe as those occurring after stopping the use of mor- 
phine. They are speedily relieved by large doses of gel- 
seminum. This drug was first used for the pains occurring 

* Lancet, May 24, 1873. 



ABRUPT WITHDRAWAL TREATMENT. 201 

in the limbs of chloral eaters, during the continuance of 
the habit, by Mr. Herbert M. Morgan.* It acted well. 
Baths, electricity, the cold pack, and the measures recom- 
mended for the treatment of the morphia habitues, should 
be used. There should be no gradual reduction, unless 
the patient is very anaemic and much debilitated. Quinine 
in twenty-grain doses is an excellent sleep producer in 
these cases. The delirium tremens is best treated by digi- 
talis and bromide of potassium. Stimulants should be 
freely used for the first three days, and strychnia and iron 
be given in large and frequently repeated doses. Cod- 
liver oil, extract of malt, and a generous diet should be 
prescribed. Pepsine should be given in fifteen to thirty 
grain doses after each meal. The bowels should be kept 
gently moving, by some mild laxative and cold water 
enemata. Hemorrhage from the bowels, stomach or urinary 
passages is readily controlled by the homoeopathic tincture 
of witch-hazel, in ten-drop doses. 

After the first ten days of treatment, strenuous efforts 
should be made to improve the patient's health and mind 
by means of exercise, free diet, good reading, and pleasant 
conversation. 

The conjunctivitis is best treated by mild astringent ap- 
plications, as tea, or the following : — 

R . Acid tannici, gr.vj 

Sodse biboratis, • . . . . gr.xv 

Vin. opii, £j 

Glycerinae, ^j 

Aq., gij. M. 

Sig. — Eye wash. 

The eye troubles and the skin affections usually pass away, 
without interference, a few days or weeks after the discon- 
tinuance of the chloral. 

* British Medical Journal, Sept. 2, 1876. 



202 THE CHLORAL HABIT. 

Restraint, full control, and a thorough search of the 
patient are necessary with these as with opium or morphine 
takers. 

The practice employed by some physicians, of "tapering 
off ' ' chloral eaters on small doses of opium or morphine, 
I consider unnecessary, and extremely dangerous, for these 
patients, as is well established, are prone to go from one 
habit to another, and the use of these drugs is placing 
needless temptation in their way. 

PROGNOSIS. 

Cure may be assured if proper control of the patient is 
had. As much depends on proper after treatment of these 
cases as in that oHhe morphine habit. 

Relapses less often occur in these than in opium 
habitues. 

Finally, then, the prolonged use of chloral is not so 
likely to form a habit; is not so thoroughly enslaving when 
formed ; is less prone to endanger life in small, more prone 
to destroy mind and body in large doses, and is easier 
broken, than the opium and morphine habits. 

DANGERS. 

There is a certain peculiar danger attending the use of 
chloral that is comparatively rare among opium habitues, viz : 
that of death from an overdose ; death, also, from a dose 
that has previously been taken with safety. * Medical 
literature is filled with records of such cases, and instances 
where death almost occurred, the patient only being saved 
through the exertions of the physician called. 

In some instances an overdose was accidentally taken ; 
in others the person is found dead, it being probable that 
he took no more than his customary dose, which, however, 

* Kane; " Deaths from Chloral Hydrate." N. Y. Medical Record, Dec, 1880. 



ABRUPT WITHDRAWAL TREATMENT. 203 

acted with unusual strength upon a system surcharged with 
the drug. 

Here, for instance, is, supposably, one of these cases. It 
is sent me by Dr. P. C. Remondino, of San Francisco, 
Cal. : — 

" Isaac H., barrister, aged fifty-six; about four years ago 
began taking chloral for sleeplessness, due, he was told, to 
cerebral anaemia; was then a portly gentleman ; hair and 
beard dark ; beard slightly tinged with gray ; feeling 
the need of stimulus, began to drink quite freely, and also 
to take morphia ; then soon followed the habitual use of 
chloral. He now takes as much as one hundred and eighty 
grains per day, in three to four doses. Sometimes takes 
ten grains of morphia with one of the doses ; is more than 
usually nervous ; now is greatly emaciated ; hair and beard 
a bleached white ; skin itches and has a hard, dry feel ; 
has small brownish spots, about the size of this Q, that 
cast off a small scab of skin ; suffers with pain in wrists and 
knees ; also elbows and ankles, but not so severely as in 
the wrists and knees ; insomnia and loss of appetite. Bowels 
regular ; mental faculties are active ; of course nothing like 
those he formerly possessed, as his physical debility makes 
him childish, but still he can use his mind and will, to a 
certain extent ; acts perfectly gentlemanly, although he is 
as stated. His physical state is that of the debility and 
tottering of a man of ninety. ' ' 

A short time afterward the doctor writes : " The chloral 
eater died some few days ago, in Los Angelos. Was found 
dead in the water closet of his hotel. The despatch says, 
' supposed cause apoplexy. ' I think it was more likely 
cardiac asthenia." 

Dr. R. F. Lewis, of Lumberton, N. C, writes me: "A 
prominent physician of this place who was intemperate in 



204 THE CHLORAL HABIT.. 

the use of spirits, morphine, etc., began the use of chloral 
instead, and for weeks or months was more or less under 
its influence. He died suddenly after using it in increased 
quantities the day and night before. No autopsy." 

Dr. A. R. Kilpatrick, of Navasota, Texas, sends me the 
following curious note: — 

" About four or five years ago there was a doctor living 
at Port Hudson, West Feliciana Parish, La., named (I 
think) Harris, who wrote several papers for the Med. and 
Surg. Reporter, of Philadelphia. He wrote one or two 
papers especially on the use of chloral and on the chloral 
habit, and very impressively warned people about its use 
and abuse, and in less than a year after the publication of 
those pieces I saw his death announced, and that he had 
been a habitual consumer of chloral, and that it killed 
him." 

Here is another case of death from an overdose, in an 
habitue, contributed by Dr. S. Henry Dessan, of this 
city : — 

" The only case where I have known death to be in any 
way connected with the administration of chloral, was in 
a case of dipsomania in a hysterical female. I prescribed 
a combination of fifteen grains of chloral with thirty grains 
of bromide of potassium, to be repeated every two hours, 
until sleep was procured ; the effect was obtained after three 
or four doses. About eight doses were given in the mix- 
ture. I ceased attending the case, and about a year after 
learned through the press that the patient had died from 
an overdose of chloral. On inquiring from the druggist 
who had prepared the prescription, I learned that the 
patient continued to use the medicine steadily after my 
visits ceased, and that for twenty-four hours before death 
she had used two bottles of the mixture, or in other words 



ABRUPT WITHDRAWAL TREATMENT. 205 

four ounces of chloral with one ounce of bromide of po- 
tassium. ' ' 

Two cases of chloral habituation in men past middle 
age are reported by Dr. C. A. Bryce of Richmond, Va., 
where death occurred from symptoms resembling apoplexy. 



THE HASHISCH HABIT. 



CHAPTER XII. 

HASHISCH INTOXICATION. 

A common practice in some of the far Eastern countries 
— hashisch taking — is comparatively rare among the people 
of civilized nations. Here, as there, the practice is not one 
of steady, daily intoxication with this drug, but it, more 
like alcohol, is resorted to at certain times, when the system 
seems especially to crave^it, or the temptation is offered. 
In this it differs materially from the practice of opium or 
morphia taking. In point of continual craving, we might, 
I think, arrange these drugs in the following order : Mor- 
phine or opium, chloral, hashisch, alcohol. 

It would seem that, as the more intense is the daily or 
hourly craving for a stimulant or narcotic, the easier it is 
to permanently destroy that craving when the habit is once 
broken. Thus a short struggle of from four to eight days 
will, in the majority of instances, cure the opium patient, 
while with alcohol or hashisch, less so with chloral, the 
desire seems to be latent and to crop out at odd times, and 
under peculiar circumstances. Once the desire is fully sat- 
isfied, then it remains quiescent for a shorter or longer 
period, to again show itself in its original, or with increased 
intensity, at a later date. Hence it is that it is so very 
difficult to permanently cure dipsomania. With the opium 

206 



EFFECTS ON THE SYSTEM. 207 

or morphine habitue, the desire at first, certain symptoms 
at a later date, come to the surface and demand a renewal 
of the drug saturation as soon as the effect of the last dose 
passes away. 

We must differentiate between a diseased mental condi- 
tion that imperatively calls for some narcotic or stimulant, 
and that craving for these substances that is only devel- 
oped after their prolonged use, and which did not exist 
before their use was begun. Both conditions are those of 
disease; the one always existing, the other springing from 
the prolonged use of the substance to which they become 
addicted. Be it distinctly understood that where, through- 
out this book, I have used the word " habit," I have 
meant an abnormal appetite or condition, calling for the 
use of narcotics or stimulants, that either existed before or 
was produced by the use of the substance in question. 

There are those who use hashisch steadily the year round, 
as many of our countrymen use alcohol; but this is due 
more to moral depravity than to any special morbid craving 
for the substance used. 

Were we able to procure a thoroughly reliable extract of 
hemp in this country, and did physicians use it as freely, 
as carelessly, and in as large doses, as they are using opium, 
morphine and chloral, hashisch takers would be more com- 
mon. 

Known in English-speaking countries as Indian Hemp 
or Cannabis Indie a, it is called Hashisch by the Arabians, 
Gunjah and Churrus by the inhabitants of India, Bust or 
Sheer a by the Egyptians, Dagga or Dacha by the Hotten- 
tots, El Mogen by the Moors. This is the solid extract. 
Bangue, Bang or Bendji is the spirituous extract.* 

Our pharmacopoeia offers a tincture of Cannabis Indica, 

* Calkins ; " The Opium Habit/' Phila., 1871. 



208 THE HASHISCH HABIT. 

every drachm of which represents fully three grains of the 
extract. Some of our manufacturing chemists prepare a 
fluid extract, and a fairly though not thoroughly reliable 
extract of hemp is manufactured by the English. 

The English extract is that usually employed for 
medicinal purposes, and for the production of intoxi- 
cation. 
y The only habitue that I have known was a woman, 
thirty-eight years of age, who consumed, daily, nine grains 
of the English extract. She would roll it up into a little 
lump, knead it for some time between the fingers, and then 
placing it in the bowl of a common clay pipe, partly filled 
with tobacco, light it, and inhale the smoke. This was 
done twice daily, about four and a half grains being used 
at a time. Sometimes she would go a week at a time — at 
least so she said — without using any ; but I suspect that 
on those days when she did not smoke it, she used it by 
the stomach. 

She was of an intensely nervous temperament, formerly 
addicted to the excessive use of alcoholic stimulants; of 
sallow complexion, dull eyes, pupils always widely dilated, 
pulse slow and irregular, occasionally intermitting a beat ; 
heart sounds feeble, body poorly nourished, skin dry, 
bowels usually loose, appetite poor, and urine scanty and 
high colored, but free from casts, albumen or sugar. She 
had been using the drug in this way about eighteen months, 
and found it necessary to occasionally increase her doses. 
She complained, especially in the morning, when waking 
from her almost cataleptic state, of intense pain in the left 
side of the head, and along the course of the sciatic nerve 
of the same side. 

She began to use the drug through curiosity, having read 
of its peculiar effects, and being extremely desirous of find- 



EFFECTS ON THE SYSTEM. 209 

ing something to supply the place of the alcohol, to which 
she had become a slave. 

When not under the influence of the drug her intellect 
was dull and sluggish, and her temper, at times, bad and 
unreasoning. During the night, when most completely 
under the influence of hemp, her dreams were highly pleas- 
urable ; she seeming to live in a different world, a thought 
being answered by its accomplishment, a wish by its fulfill- 
ment i distances were traversed in a few seconds ; feasts, 
marked by plenty and variety, the food on dishes of gold, 
studded with diamonds and other precious stones, were set 
before her. Everything was done on a scale of magnifi- 
cence. At times the dreams partook of a highly lascivious 
character. She assured me that she seemed to be living a 
double life — the one the real, the other that produced by 
the hemp. In the latter the incidents of one night's dreams 
seemed to follow as regularly, and the characters to be as 
real, as the incidents and people of every day life. 

There was one peculiarity : if she took a little more than 
her usual allowance of the drug, she found her dreams of 
an entirely different nature ; not pleasant, but inexpressibly 
horrible, new faces and new scenes taking the place of the 
usual ones, the thread of her dream romance being sud- 
denly snapped. The same thing occurred, though not so 
markedly, if she took less than the usual amount. 

Before commencing the use of this drug she was in fair 
health, stout, and when not under the influence of liquor, 
bright and cheerful. 

She passed entirely away from my observation, and I 
have never since been able to learn what became of her, 
though I heard once that she had died, how or when I do 
not know. 

I once saw her in one of those deep sleeps produced by 



210 THE HASHISCH HABIT. 

hashisch, and noted that there seemed to be complete 
anaesthesia, deep snoring respiration, thirteen to the min- 
ute, dilated and irregular pupils, purplish congestion of 
the face and conjunctivae, and a spasmodic twitching of the 
left eyelid that lasted all the time I was with her — two 
hours. 

She was possessed of some money, and was very highly 
educated. She claimed to be the widow of an English 
army surgeon. 

In the morning she rarely smoked all that was put in the 
pipe, and never enough to put her to sleep. Occasionally 
she added a little opium to the hemp. She was a mental 
and bodily wreck. Her gait was tottering, and sometimes 
she would be forced to go in a direction opposite to that 
in which she desired to move. 

She expressed no desire to be broken of her vice, saying 
often that if she wished it she could stop without any 
trouble. I regret exceedingly that her temper and many 
peculiarities would not permit my studying her case more 
closely. The urine examined was obtained by catheteriza- 
tion during the semi-cataleptic spell already spoken of. 

The mental effect of this drug has been variously de- 
scribed by different authors. Thus, Calkins* says : — 

' l ThQj^nt alcondilio n is an ideal existence, the most 
vivid, the most fascinating. Time and space both seem to 
have expanded by an enormous magnification ; pigmies 
have swelled to giants, mountains have grown out of mole- 
hills, days have enlarged to years and ages. De Moria 
in wending his way one evening to the opera house, seemed 
to himself to have been three years in traversing the corri- 
dor. De Saulcy having once fallen into a state of insensi- 
bility following upon incoherent dreamings, fancied he 

* Op. cit. p. 323. 



EFFECTS ON THE SYSTEM. 211 

had lived meanwhile a hundred years. Rapidity as well 
as intensity of thought is a noticeable phenomenon. De 
Lucca, after swallowing a dose of the paste, saw, as in a 
flitting panorama, the various events of his entire life, all 
proceeding in orderly succession, though he was powerless 
in the attempt to arrest and detain a single one of them for 
a more deliberate contemplation. Memory is sometimes 
very singularly modified nevertheless, there being perhaps 
a forgetfulness, not of the object, but of its name proper, 
or the series of events that transpired during the paroxysm 
may have passed away into a total oblivion. 

"The normal mental condition \s that of an exuberant 
enjoyance rather than the opposite, that of melancholy 
and depression, though the transition from the one state 
to the other may be as extreme as it is swift. Oftener the 
subject is kept revolving in a delirious whirl of hallucina- 
tory emotions, when images the most grotesque and illu- 
sions the drollest and most fantastic crowd along, one upon 
another, with a celerity almost transcending thought. 
(Mirza Abdul Roussac.) 

" Command over the will is maintainable, but temporarily 
only. As self-control declines the mind is swayed by the 
mere fortuitous vagaries of the fancy ; and now it is that 
the dominant characteristic or mental proclivity has its 
real apocalypsis. The outward expression may reveal itself 
under a show of complacency and contentment in view 
of things around, or suspicion, distrust, or querulousness of 
disposition may work to the surface, or may be, a lordly 
hauteur that exacts an unquestioning homage from the 
' profanum vulgus' by virtue of an affected superiority over 
common mortals, is the ruling idea of the hour ; or per- 
adventure, the erotic impulses may, for the time, over- 
shadow and disguise all others. 



212 THE HASHISCH HABIT. 

"Amid the ever-shifting spectacular scene the sense of 
personal identity is never perhaps entirely lost, but there does 
arise in very rare instances the notion of a duality of exist- 
ence; not the Persian idea precisely, that of two souls 
occupying one and the same body in a joint stock associa- 
tion, as it were (the doctrine as alluded to by Xenophon, 
in the story of the beautiful Panthea), but rather the idea 
of one and the same soul in a duplication or bipartation 
else, and present in two bodies." 

Many persons who have put themselves once or twice 
under the influence of this drug claim that no such pleasant 
effects, but rather torturing and horrible conditions are pro- 
duced. The results when the drug is taken in this way, 
like those produced by tobacco on boys who smoke for the 
first time, should not be taken as a true estimate of the 
results obtained by the continued use of either. 

A curious, interesting and valuable experiment was made 
upon himself by Dr. H. C. Wood, of Philadelphia, who is 
especially qualified to undertake and record the results of 
such an observation. 

He says*: — 

"When given in full doses, cannabis Indica produces a 
feeling of exhilaration, with a condition of reverie, and a 
train of mental and nervous phenomena, which varies very 
much according to the temperament or idiosyncrasies of 
the subject, and very probably also, to some extent, accord- 
ing to the nature of his surroundings. The sensations are 
generally spoken of as very pleasurable ; often beautiful 
visions float before the eyes, and a sense of ecstacy fills the 
whole being • sometimes the venereal appetites are greatly 
excited ; sometimes loud laughter, constant giggling, and 
other indications of mirth are present. Some years since, 

* Materia Medica and Therapeutics, Phila., 1877, p. 226. 



EFFECTS ON THE SYSTEM. 213 

in experimenting with the American extract, I took a very 
large dose, and in the essay upon the subject {Proceedings 
of the American Philosophical Society, 1869, vol. xi. p. 226), 
the result was described as follows: — 

" ' About half-past four p.m., September 23, I took most 
of the extract. No immediate symptoms were produced. 
About seven p.m. a professional call was requested, and, 
forgetting all about the hemp, I went out and saw my 
patient. While writing the prescription I became per- 
fectly oblivious to surrounding objects, but went on writing, 
without any check to or deviation from the ordinary series 
of mental acts connected with the process, at least that I 
am aware of. When the recipe was finished, I suddenly 
recollected where I was, and, looking up, saw my patient 
sitting quietly before me. The conviction was irresistible 
that I had sat thus many minutes, perhaps hours, and 
directly the idea fastened itself that the hemp had com- 
menced to act, and had thrown me into a trance-like state 
of considerable duration, during which I had been stupidly 
sitting before my wondering patient. I hastily arose and 
apologized for remaining so long, but was assured I had 
only been a very few minutes. About seven and a half 
p.m. I returned home. I was by this time quite excited, 
and the feeling of hilarity now rapidly increased. It was 
not a sensuous feeling, in the ordinary meaning of the 
term ; it was not merely an intellectual excitation ; it was 
a sort of bien-etre — the very opposite to malaise. It did 
not come from without ; it was not connected with any 
passion or sense. It was simply a feeling of inner joyous- 
ness 1 the heart seemed buoyant beyond all trouble ; the 
whole system felt as though all sense of fatigue were for- 
ever banished ; the mind gladly ran riot, free constantly to 
leap from one idea to another, apparently unbound from 



214 THE HASHISCH HABIT. 

its ordinary laws. I was disposed to laugh ; to make comic 
gestures ; one very frequently recurrent fancy was to imi- 
tate with the arms the motions of a fiddler, and with the 
lips the tune he was supposed to be playing. There was 
nothing like wild delirium, nor any hallucinations that I 
remember. At no time had I any visions, or at least any 
that I can now call to mind ; but a person who was with 
me at that time states that once I raised my head and ex- 
claimed, i Oh, the mountains! the mountains!' While 
I was performing the various antics already alluded to, I 
knew very well I was acting exceedingly foolishly, but 
could not control myself. I think it was about eight 
o'clock when I began to have a feeling of numbness in my 
limbs, also a sense of general uneasiness and unrest, and a 
fear lest I had taken an overdose. I now constantly walked 
about the house ; my skin, to myself, was warm — in fact, my 
whole surface felt flushed ; my mouth and throat were very 
dry; my legs put on a strange, foreign feeling, as though 
they were not a part of my body. I counted my pulse and 
found it one hundred and twenty, quite full and strong. 
A foreboding, an undefined, horrible fear, as of impending 
death, now commenced to creep over me ; in haste I sent 
for medical aid. The curious sensations in my limbs in- 
creased. My legs felt as though they were waxen pillars 
beneath me. I remember feeling them with my hand and 
finding them, as I thought, at least, very firm, the muscles 
all in a state of tonic contraction. About eight o'clock I 
began to have marked ' spells' — periods when all connec- 
tion seemed to be severed between the external world and 
myself. I might be said to have been unconscious during 
these times, in so far that I was oblivious to all external 
objects, but on coming out of one it was not a blank, 
dreamless void, upon which I looked back, a mere empty 



EFFECTS ON THE SYSTEM. 215 

space, but rather a period of active but aimless life. I do 
not think there was any connected thought in them \ they 
seemed simply wild reveries, without any binding cord — 
each a mere chaos of disjointed ideas. The mind seemed 
freed from its ordinary laws of association, so that it passed 
from idea to idea, as it were, perfectly at random. The 
duration of these spells, to me, was very great, although they 
really lasted but a few seconds to a minute or two. Indeed, 
I now entirely lost my power of measuring time. Seconds 
seemed hours ; minutes seemed days ; hours seemed infinite. 
Still I was perfectly conscious during the intermissions be- 
tween the paroxysms. I would look at my watch, and 
then, after an hour or two, as I thought, would look again, 
and find that scarcely five minutes had elapsed. I would 
gaze at its face in deep disgust, the minute-hand seemingly 
motionless, as though graven in the face itself; the laggard 
second-hand moving slowly, so slowly it appeared a 
hopeless task to watch during its whole infinite round of a 
minute, and always would I give it up in despair before 
the sixty seconds had elapsed. Occasionally, when my 
mind was most lucid, there was in it a sort of duplex action 
in regard to the duration of time. I would think to myself, 
it has been so long since a certain event — an hour, for 
example, since the doctor came ; and then reason would 
say, no, it has been only a few minutes ; your thoughts or 
feelings are caused by the hemp. Nevertheless, I was not 
able to shake off this sense of the almost indefinite pro- 
longation of time, even for a minute. The paroxysms 
already alluded to were not accompanied with muscular re- 
laxtion. About a quarter before nine o'clock I was stand- 
ing at the door, anxiously watching for the doctor, and 
when the spells would come on I would remain standing, 
leaning slightly, perhaps, against the doorway. After 



216 THE HASHISCH HABIT. 

awhile I saw a man approaching, whom I took to be the 
doctor. The sound of his steps told me he was walking 
very rapidly, and he was under a gas-lamp, not more than 
one-fourth of a square distant, yet he appeared a vast dis- 
tance away, and a corresponding time approaching. This 
was the only occasion in which I noticed an exaggeration 
of distance; in the room it was not perceptible. My ex- 
tremities now began to grow cold, and I went into the 
house. I do not remember further, until I was aroused by 
the doctor shaking or calling me. Then intellection 
seemed pretty good. I narrated what I had done and 
suffered, and told the doctor my opinion was that an 
emetic was indicated, both to remove any of the extract 
still remaining in my stomach, and also to arouse the 
nervous system. I further suggested our going into the 
office, as more suitable than the parlor, "where we then 
were. There was at this time a very marked sense of 
numbness in my limbs, and what the doctor said was a hard 
pinch produced no pain. When I attempted to walk up- 
stairs my legs seemed as though their lower halves were 
made of lead. After this there were no new symptoms, 
only an intensifying of those already mentioned. The 
periods of unconsciousness became at once longer and 
more frequent, and during their absence intellection was 
more imperfect, although when thoroughly aroused I 
thought I reasoned and judged clearly. The oppressive 
feeling of impending death became more intense. It was 
horrible. Each paroxysm would seem to have been the 
longest I had suffered ; as I came out of it a voice seemed 
constantly saying, ' You are getting worse; your par- 
oxysms are growing longer and deeper ; they will over- 
master you; you will die.' A sense of personal antago- 
nism between my will power, as affected by the drug, grew 



EFFECTS ON THE SYSTEM. 217 

very strong. I felt as though my only chance was to 
struggle against these paroxysms — that I must constantly 
arouse myself by an effort of will ; and that effort was made 
with infinite toil and pain. I felt as if some evil spirit had 
control of the whole of me, except the will power, and 
was in determined conflict with that, the last citadel of my 
being. I have never experienced anything like the fearful 
sense of almost hopeless anguish and utter weariness which 
was upon me. Once or twice during a paroxysm I had 
what might be called nightmare sensations ; I felt myself 
mounting upward, expanding, dilating, dissolving into the 
wide confines of space, overwhelmed by a horrible, rend- 
ing, unutterable despair. Then, with tremendous effort, I 
seemed to shake this off, and to start up with the shudder- 
ing thought, next time you will not be able to throw this 
off, and what then? Under the influence of an emetic I 
vomited freely, without nausea, and without much relief. 
About midnight, at the suggestion of the doctors, I went 
up-stairs to bed. My legs and feet seemed heavy, I could 
scarcely move them, and it was as much as I could do to 
walk with help. I have no recollection whatever of being 
undressed, but am told I went immediately to sleep. 
When I awoke, early in the morning, my mind was at first 
clear, but in a few minutes the paroxysms, similar to those 
of the evening, came on again, and recurred at more or 
less brief intervals until late in the afternoon. All of the 
day there was marked anaesthesia of the skin. At no time 
were there any aphrodisiac feelings produced. There was 
a marked increase of the urinary secretion. There were no 
after effects, such as nausea, headache, or constipation of 
the bowels. 

"The sense of prolongation of time which I experienced 
was to me very remarkable, but is not uncommon in these 



218 THE HASHISCH HABIT. 

cases. It is evidently due to the immense rapidity of the 
succession of ideas. The mind, without doubt, measures 
time by the duration of its own processes, and when an 
infinitude of ideas arise before it in the time usually occu- 
pied by a few, time becomes infinitely prolonged to the 
mind. It is a lifetime in the minute. A very common 
mental phenomenon, not yet mentioned, is a condition of 
double consciousness, a sense of having two existences, of 
being at the same time one's self and somebody else." 

Pleasurable as may be the stage of excitement or intoxi- 
cation, fascinating as may be the dreams that follow, the 
evil effect upon the body is rapid and decisive. 

Wasting of the muscles, sallowness of the skin, hebetude 
of the mind, interference with coordination, failure of the 
appetite, convulsive seizures, loss of strength, and idiotic 
offspring, seem, from all accounts, to be the uniform result 
of the long continued use of this drug. 



CONCLUSIONS. 219 

CHAPTER XIII. 

CONCLUSIONS. 

A careful study of the facts presented in the foregoing 
chapters teach us several lessons well worth considering, 
and suggest certain cautions and reforms that are greatly 
needed. 

From the abundant evidence upon this point I think we 
must conclude that the abuse or habitual use of narcotics 
is steadily upon the increase, especially the subcutaneous 
use of morphine ; that these drugs are, in the majority of 
instances, first taken to relieve pain, and not for simple 
gratification of a morbid appetite ; and that the drug used 
and the manner of using it is in consonance with the preva- 
lent medical practice of the time in which the habitue 
lives. 

There are two classes especially blamable for this — the 
physicians and the druggists. In the early history of the 
use of the hypodermic syringe the danger of contracting 
the habit through its frequent use was not recognized, and 
the physician was not then to blame. At the present time, 
however, knowing fully the dangers incident to its use, the 
physician is criminally careless in placing the instrument 
in the hands of the patient or her friends for their use. If 
he does not appreciate the full extent of the danger, 
he is culpably ignorant, and certainly deserving of punish- 
ment. 

The deaths, and dangerous accidents, and the spread of 
the continued use of narcotics, is due, to a great extent, to 
the druggists, who, in many cases, sell the drug without a 



220 CONCLUSIONS. 

physician's prescription, and without any reasonable excuse 
on the part of the patient, in direct violation of the law. 
Chloral is sold to men just recovering from a spree ; pre- 
scriptions containing large amounts of these drugs are 
renewed for patients for whom they were not originally 
given ; the druggist himself often prescribes a mixture of 
chloral, morphine and bromide of potassium, for repentant 
drunkards, or for patients suffering from insomnia. 

When spoken to about this matter, they coolly excuse 
their practices with the remark that "if we don't do it, 
some other druggist will; and why should we lose the 
money. ' ' The laws relating to the sale of poisons are loose 
and inefficient, the practice rotten, and the statute really 
a dead letter. Dangerous and even fatal consequences* 
are not, then, so much to be wondered at. 

Another matter in this connection needs attention, viz : 
the lying pretensions of a few charlatans, notably in the 
West, who, by specious advertisements and deceitful lies, 
induce the victims to these habits to buy their medicines, 
or come under their care for treatment. Their so-called 
specifics are simply preparations of opium or morphine, 
and their treatment is based upon the plan of substituting 
onefor?n of the drug for another. 

These sharpers are utterly without conscience, and do 
not scruple to prey upon and undermine the health of their 
victims, in order to gain a few dollars. It is about time 
that the people found out that honest, honorable and trust- 
worthy physicians, who have only the good of the patient 
at heart, do not advertise. It is a shameful fact that the 
religious press tolerates the advertisements of these charla- 
tans in their columns. As a rule, the vilest advertisements 
are to be found in these newspapers. Owing to the moral 

* Kane ; " Deaths from Chloral." N. Y. Medical Record, Dec. 25, 1880, Jan. 1, 1881. 



CONCLUSIONS. 221 

weight supposed to be carried by these sheets, owing to 
their large circulation among the people, who look upon 
every word therein contained as truth, these announcements 
and endorsements do the people an infinite amount of 
harm. Can it be that the financial "backers" of these 
papers overrule the scruples of the religious editor ? If so, 
while a good investment financially, it must be a very poor 
one morally. 

I have emphasized the fact that the continued use of 
chloral is not so liable to end in the formation of a habit, 
as is the prolonged use of morphia or opium ; not that phy- 
sicians may exercise less care and discrimination in its 
employment, for the danger is sufficiently great, but simply 
to refute the statements of some men who are gone wild 
upon the subject of habituation and inebriety, and who 
suggest measures for reform, and plans for restraint and 
treatment, as impracticable and impossible as their state- 
ments are whimsical and truthless. # 

Finally, be it distinctly understood, that many of the 
symptoms enumerated as occurring in both the morphine 
and chloral habitues, but especially the latter, are only 
found where the drug has been used in large amount, or 
for a long time. Every symptom will, moreover, be 
modified somewhat by the systemic peculiarities of each 
patient. 

The "mixed" habits, so called, where patients are using 
two or more narcotics at one time, have not been discussed 
separately, as they possess no distinctive characters, and 
the physician who understands the prominent points of 
each will have no trouble in detecting and treating these 
cases. 



INDEX. 



A. 

Abortion from excessive use of morphia, 

43- 
Abscess from hypodermic injection of 

morphia, 71. 
Absorption of morphia, rapidity of, 83. 
Accidents from subcutaneous use of mor- 
phia, 71. 
Ady, Dr. A., case by, 152. 
After-treatment of opium and morphia 

habits, 140. 
Ages of opium and morphia takers, 25. 

of chloral takers, 150. 
Akland, Dr. Fr., on chloral habit, 151. 
Albuminuria from continued use of opi- 
ates, 46. 
in chloral takers, 182. 
Alcoholic stimulants used by opium tak- 
ers, 38. 
in treatment of morphia-mania, 139. 
Allbutt, Dr. T. Clifford, observations of, 

54- 
Alopecia, in morphia takers, 40. 
Amaurosis from continued use of opiates, 

47- 
in chloral takers, 197. 
Amidon, Dr. R. W., experiments of, 99. 
Andrews, Dr. Judson B., case by, 54. 
Anstie, Dr., case by, 175, 178. 
Aphasia from prolonged use of chloral, 

171. 
Arton, Dr. J. H., case by, 180. 
Ascites from excessive use of morphia, 

35, 36. 
Atkinson, Dr. A., case by, 76. 

B. 

Barker, Dr. Fordyce, 29. 

Barkitt, Dr. F. W., case by, 102. 

Bartholow, Prof. Roberts, observations 
of, 90. 
case by, 72. 

Baths in treatment of morphia takers, 130. 

Beaumetz-Dujardin, case by, 71. 

Belladonna in treatment of morphia tak- 
ers, 136. 

Bidlack, Dr., case by, 152. 

Bigelow, Dr. H. C, case by, 184, 198. 

Bile, effects of continued use of opiates 
on, 37. 

Blalock, Dr. W. C, hydrocyanic acid in 
treatment of opium habit, 137. 

Blood, effects of chloral on, 186. 

" Bloating" in morphia takers, 39. 

Bond, Dr. Thos., case by, 170. 

Bouchut, chloral diabetes, 182. 

Braine, Dr. F. W., case by, 88. 

Bradley, Dr. Edward, cases by, 184, 199. 

Brandeis, Dr. R. C, case by, 180. 

Brown-Sequard on chloral paralysis, 178. 

Bromides in the treatment of opium tak- 
ers, 136. 

Bryce, Dr. C. A., case by, 205. 

Bunting, Dr. James, case by, 170. 

C. 

Cable, Dr. W. W., case by, 91. 
Calkins, Dr. Alonzo, observations of, 44, 

210. 
Calvet, observations of, 96. 



Cannabis Indica in treatment of opium 
habit, 137. 
continued use of, 206. 
Capsicum in treatment of opium habit, 

136. 
Casts in urine of morphia takers, 46. 
Change from opium to alcohol, etc., 38. 
Chills, nervous, in chloral takers, 177. 
Chloral hydrate, continued use of, 149. 

in treatment of opium 
habit, 137. 
Circulation, effects of chloral on, 186. 

in morphia takers, 48. 
Civil condition of chloral takers, 150. 
Civilization as a modifier of the nervous 

system, 17. 
Claggett & Walls* Drs., case sent by, 118. 
Clark, Dr. Alonzo, case by, 93. 
Clinical Society of London, report of, 

149. 
Coca in treatment of opium habit, 136. 
Coleridge, amount of opium used by, 27. 
Color of skin in morphia takers, 38. 
Compton, Dr. W. M., observations of, 

J 55- 
Constipation in opium takers, 37. 
Corona, injection of drugs into veins, 90. 
Cram, Dr. C. W., observations of, 155. 
Craving for stimulants and narcotics, 33, 

207. 
Crotners, Dr. T. D., case by, 173. 
Cullen, Dr. C. R., observations of, 194. 

D. 
Dabbs, Dr. G. H. R., case by, 186. 
Dangers, of chloral habit, 202. 
Davis, Dr. G. W., case by, 171. 
Deaths from chloral, 202. 
Delmont, Dr. F., case by, 194. 
Delirium in abandoning chloral, 200. 
Dessau, Dr. S. Henry, case by, 204. 
DeQuincey, confessions of, 22, 33. 

preparation and amount 
used by, 27. 
Diabetes from morphia taking, 41, 46, 47. 

chloral taking, 182. 
Diet in the treatment of morphia absti- 
nence, 138. 
Digestive apparatus, effect of opiates on, 
34- 
chloral on, 180. 
Diplopia from excessive use of morphia, 

47- 
Diseases of the present day, peculiarities 

of, 17. 
Doane, Dr. H. H., case by, 172, 185. 
Douche, cold, uses of, 131. 
Dover's powder, 27. 
Dreams, 19, 20. 

Drunkards, use of chloral by, 163. 
Dyspepsia in opium takers, 34, 142. 
Dyspnoea in chloral takers, 195. 

E. 
Earle, Dr. C. Warrington, observations 

of, 24. 
Electricity in treatment of opium takers, 

132. 
Elliot, Dr. Geo. F., case by, 200. 
Eruptions in morphia takers, 37, 38. 



INDEX. 



223 



Erysipelas from subcutaneous injection 

of morphine, 74. 
Eyes, effect of prolonged use of opiates on, 

47- 
chloral on, 197, 201. 
F. 
Faeces, in morphia-mania, 36, 37. 
Feltz & Ritter on chloral diabetes, 182. 
Folsom, Dr. Norton, case by, 113. 
Formation of opium and morphine habits, 

18, 31, 32. 
Fowler, Dr. Geo. R., observations of, 84. 
Francis, Dr. Sam'l W., case by, 84. 
Fry, Dr. Frank H.,case by, 172. 

G. 
Gastric juice, effect of opiates on secre- 
tion of, 34. 
catarrh in opium takers, 35. 
Georges & Bernard-Claude, experiments 

of, 92. 
Graham, Dr. Arthur, case by, 78. 
Griswold, Dr. Gaspar, experiments of, 97. 

a. 

Habit, opium, how formed, 18. 

Hemorrhoids in morphia habitues, 37. 

Hemorrhage from mucous surfaces in 
chloral takers, 182, 201. 

Hair, falling of in opium takers, 40. 

Ham, Dr. O. F., case by, 185. 

Harrington, Dr. H. L., case by, 80. 

Hashisch habit, 206. 

Hayne, Dr. A. P., observations of, 171. 

Haywood, Dr. Burke, case by, 198. 

Heartburn in morphia takers, 37. 

Herpes zoster in morphia takers, 40. 

Holbrook, Dr. M. L., cases by, 153. 

Houtz, Dr. J. A., observations of, 87. 

Husted, Dr. N. C., case by, 198. 

Hutchinson, Dr. Wm. F., case by, 132. 

Hydrocyanic acid in treatment of mor- 
phia taking, 137. 

Hypodermic injection of morphia, 24, 30, 

145- 
Hysteria, how modified by opiates, 54. 

Impaction of faeces, 37. 

Impotence from prolonged use of opiates, 

45- 
Incoherence of morphia takers, 53. 
Ingals, Dr. E. F., case by, 79. 
Inglis, Dr. T., case by, 159. 
Injection of morphine into a vein, 75. 
Insanity from continued use of chloral, 
168. 
opiates, 52. 
Insomnia, best remedy for, 140. 
Intellectual grade of opium takers, 25. 

J. 
Jaundice from continued use of opiates, 

35, 37> 38. 
Jewell, Prof. J. S., observations of, 84. 
Jones, Dr. N. Jasper, case by, 163. 
Dr. E., case by, 76. 
K. 
Kane, Dr. H. H., experiments of, 95, 98. 
Keyes' solution of morphia, 72. 
Keyser, case by, 198. 
Kidneys, effect of prolonged use of opi- 
ates on, 39, 46. 
Kiernan, Dr. J. G., observations of, 192. 
Kilpatrick, Dr. A. R., case by, 204. 



King, Dr. Willis P., case by, 168. 

Kinsman, Dr. D. N., case by, 169. 

Kirn, Dr. Ludwig, observations of, 187, 
195. 

L. 

Labbee, chloral diabetes, 182. 

Lactucarium, 138. 

Lee, Dr. Benj., case by, 175. 

Leucorrhoea in opium takers, 43, 141. 

Levenstein, observations and experiments 
of, 30, 42, 45, 47, 62, 106, 107, 182. 

Lewis, Dr. Morris J., observations of, T83. 
Dr. R. F., case by, 203. 

Ligature in subcutaneous medication, 100. 

Lobelia, 137. 

Locomotion in opium takers, 48. 

Loose, Dr., observations of, 30. 

Lupulin, 138. 

Lusk, Prof. W. T., observations of, 94. 

Lying propensities of opium takers, 52, 
53- 

Lyman, Prof. H. M., case by, 154. 
M. 

MacDonald, Dr. Carlos F., on the chlo- 
ral habit, 152. 

Malaria, symptoms of, in opium takers, 
62. 

Mattison, Dr. J. B., observations of, 30, 

136, 175, 17 8 , x 79- 
Marsh, Dr. Madison, observations of, 

x 55- 
Maudsley on chloral in insanity, 171. 
McAllister, Dr. W. F., case by, 30. 
Medico-Chirurgical Society's cases and 

experiments, 83, 98. 
Meldon, Dr. Austin, case by, 103. 
Memory, effect of continued use of chloral 
on, 170. 
hashisch on, 211. 
Menstruation in morphia takers, 41, 142. 

chloral takers, 185. 
Miller, F. H., case by, 84. 
J. A., case by, 184. 
Mind, effect of prolonged use of opiates 
on, 49. 
chloral on, 165. 
hashisch on, 211. 
Morgan, Dr. Herbert M., observations 

of, 201. 
Morphia habit, the, 17. 

subcutaneous use of, 24, 30, 145. 
M'Rae, Dr. A. E., case by, 193. 
Murphy, Dr. W. Kirkpatrick, cases by, 

165, 17S. 
Muscae volantes, 47. 

Muscular system, effect of continued use 
of opiates on, 48. 
effect of continued use 
of chloral on, 194. 
N. 
Neal, Dr. W. A., case by, 77. 
Nervous element, growth of, 17, 18. 

system, condition of, in opium 

takers, 53. 
system, condition, of, in chloral 
takers, 174. 
Neuralgia from prolonged use of opiates, 
53, 142. 
chloral, 174, 175. 
Neurasthenic 'patients, danger of using 
narcotics and stimulants with, 31, 32. 



224 



INDEX. 



Nordlin, Dr. J. H., observations of, 151. 

case by, 185. 
Nose, reddening of, in opium takers, 39. 
Nussbaum, Prof., case by, 84. 

O. 
" Observer," case by, 85. 
CEsophagus, paralysis of, 180. 
Opium habit, the, 17. 
smoking, 29. 
preparations of, 27. 
P. 
Pack, the cold, 131. 
Paralysis from continued use of chloral, 

177. 
Park, Dr. Roswell, case by, 170. 
Parker, Prof. Willard, case by, 94. 
Parrish, Dr. Jos., observations of, 21, 

153- 

Pathology of opium and morphine habits, 
17-27. 

Pepper, Prof. Wm., intravenous injection 
of milk, 87. 

Pepy's Journal, extract from, 95. 

Personal experiences of an ex-opium hab- 
itue, 50. 

Perrigo, Dr. James, case by, 171. 

Perspiration in opium habitues, 39. 

Pflueger's theory of artificial menopause, 
42. 

Photophobia from chloral, 197. 

Physicians, how to blame, 18. 

Pollak, Dr., on chloral habit, 155. 

Pollock, Dr. C, case by, 173. 

Pregnancy in morphia takers, 43. 

Preparations of opium commonly used, 27. 

Preservatives for morphia solutions, 74. 

Prevalence of the opium habit, 18. 

Progeny, effect of continued use of mor- 
phine on, 44. 

Prognosis in opium habituation, 143. 
chloral habituation, 202. 

Purpura hemorrhagica from excessive 
use of morphine, 35, 40. 

Q. 

Quantity of opium and morphine used by 

habitues, 28. 

R. 
Rapidity of absorption of morphine, 98. 
Reiman, Dr., observations of, 151. 
Remondino, Dr. P. C, case by, 203. 
Respiration, effects of chloral on, 195. 
Richardson, Dr. B. W., on the chloral 

habit, 156. 
Roberts, Arthur, case by, 89. 

Dr. John, observations of, 183. 
S. 
Schlaugenhausen, Dr., opinions of, 151. 
Schule, observations of, 193, 198. 
Seguin, Dr. E. C, case by, 78. 
Semen, condition of, in opium habitues, 

45- 
Sensation modified by prolonged use of 

opiates, 41, 70. 
Sex of opium habitues, 25. 
chloral takers, 150. 
Sexual organs, effects of continued use of 
opiates on, 41. 
effects of continued use of 
chloral on, 184. 
Shettle, Dr. R. C, observations of, 194. 
Shurtleef, Dr. G. A., observations of, 153. 



Skin, effects of continued use of opiates 
on, 38, 71. 
chloral on, 187. 
Sleep of morphia takers, 49. 
Sleightholme, Dr. J. Pennock, case by, 

90. 
Smith, Prof. A. A., on chloral habit, 152. 
Dr. Q. C, observations of, 164. 
Dr. Nathan R., observations of, 
192. 
Specific gravity of urine in morphia tak- 
ers, 46. 
chloral takers, 183. 
" Spectator," case by, 85. 
Sterility from continued use of opiates, 42. 
Stimulants, 139. 

Stools, character of, in opium habitua- 
tion, 36. 
Strangury from prolonged use of opiates, 

Stramonium, 137. 
Strychnia, 136. 

Sudden deprivation, dangers of, 127. 
Symptoms of abstinence from ^morphia, 
125. 
chloral, 200 
T. 
Taylor, Dr. Isaac E., 29. 
Temper in opium habitues, 49. 
Temperament of chloral takers, 162. 
Testicles, atrophy of, 45. 
Tetanus from subcutaneous injections, 

101. 
Thomas, Prof. T. Gaillard, cases by, 31. 
Thornley, Dr. J. G., use of chloral in in- 
sanity, 151. 
Treatment of opium and morphine habits, 
106. 
chloral habit, 200. 
Tupper, Dr. Aug. M., case by, 80. 
Turnbull, observations of, 194. 

U. 
Upham, Dr. W. R., case by, 177. 
Upshur, Dr. J. N., cases by, 184. 
Urinary organs, effect of continued use 
of opiates on, 46. 
effect of continued use 
of chloral on, 181. 
V. 
Vaginismus from continued use of opiates, 

43, 62. 
Vaso-motor disturbances due to chloral, 

177. 
Veiled Prophet of Khorassan, 51. 
Veins, puncture of, by hypodermic needle^ 

IS, 
Vertigo in chloral habitues, 179. 
Vesical tenesmus from opium habituation, 

62. 
Von Mering and Museums, uro-chloralic 

acid, 183. 

W. 
Washington, Dr., 29. 
Webb, Dr. J. W. F., cases by, 184, 192. 
Wells, Spencer, observations of, 194; 
Wenger, Dr. E., case by, 88. 
Wilson, Dr. E. T., case by, 78. 
Wood, Alexander, 29. 

Prof. H. C., cases by, 83. 

on hashisch, 212. 
Woodling, Dr. M. E., case by, 75. 



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WATER ANALYSIS For Sanitary Purposes, with Hints for 
the Interpretation of Results. By E. Frankland, ph.d., d.c.l. Illus- 
trated. 12mo. Cloth. Price $1.00. 

"The name of the author is a sufficient testimonial to its accuracy and its 
practical value." — Boston Journal of Chemistry. 

BY THE SAME AUTHOR. 

HOW TO TEACH CHEMISTRY. Beine Six Lectures to 
Science Teachers. Illustrated. 12mo. Cloth. Price $1.25. 

THE ART OF PERFUMERY. The Methods of Obtaining 
the Odors of Plants and Instruction for the Manufacture of Perfumery, 
Dentifrices, Soap, etc. etc. By Gr. W. Septimus Piesse. 4th edition 
enlarged. 366 illustrations. 8vo. Cloth. Price $5.50. 

POTABLE WATER. How to Form a Judgment on the Suit- 
ableness of water for Drinking Purposes. By Charles Ekin. 12mo. Price 
75 cents. 

HEALTH RESORTS of Europe, Asia and Africa. The result 
of the Author's own observations during several years of health travel 
in many lands. By T. M. Madden, m.d. 8vo. Cloth. Price $2.50. 

THE OCEAN AS A HEALTH RESORT. A Handbook of 
Practical Information as to Sea Voyages. For the Use of Invalids and 
Tourists. By Wm. S. Wilson, m.d. Illustrated by a chart showing 
the ocean routes of staamers, and the physical geography of the sea. 
12mo. Cloth. Price $2.50. 

DWELLING HOUSES and Their Sanitary Arrangements and 
Construction. By W. H. Corfleld. Illustrated. 12mo. Cloth. Price $1.25. 

DRAINAGE FOR HEALTH. Easy lessons in Sanitary Sci- 
ence. By Joseph Wilson, m.d. Illustrated. 8vo. Cloth. Price $1.00. 

SANITARY EXAMINATION OF WATER, AIR AND 
Food. By Cornelius B. Fox, m. d. 94 engravings. 12mo. Cloth. 
Price $4 00. 

NUTRITION IN HEALTH AND DISEASE. A Contribu- 
tion to Hygiene and Medicine. 3d edition. By J. Henry Bennett, m.d. 
8vo. Cloth. Price $2.50. 

HYGIENE AND CLIMATE in the Treatment of Consump- 
tion. 3d edition. By J. Henry Bennett, m.d. 8vo. Cloth. Price $2.50. 

PRACTICAL HYGIENE. A Complete Manual for Army and 
Civil Medical Officers, Boards of Health, Engineers and Sanitarians. 
5th edition. With many illustrations. By Ed. A. Parkes, m.d. 8vo. 
Cloth. Price $6.00. 

VOCAL HYGIENE AND PHYSIOLOGY. With special 
reference to the Cultivation and Preservation of the Voice. For 
Singers and Speakers. With engravings. By G-ordon Holmes, m.d. 
12mo. Cloth. Price $2.00. 



Presley Blakiston's Select List 



WORKS ON CHEMISTRY. 

CHEMISTRY, INORGANIC AND ORGANIC. With Ex- 
periments and a Comparison of Equivalent and Molecular Formulae. 
295 Engravings. By C. L. Bloxam. 4th London edition revised. 8vo. 
Cloth. Price $4.00. 

NOTES FOR CHEMICAL STUDENTS. Compiled from 
Fowne's and Other Manuals. By Albert J. Bernays, ph.d. 6th edition 
16mo. Cloth. Price $1.25. 

MEDICAL AND PHARMACEUTICAL CHEMISTRY. 

Synthetical, Descriptive and Analytical. 2d edition, completely re- 
arranged and revised. By John Muter, m.a., m.d. Royal 8vo. Cloth. 
Price $6.00. 

HANDBOOK OF MODERN CHEMISTRY, Organic and 
Inorganic. ByC. MeymottTidy, m.d. 8vo. 600 pages. Cloth. Price $5.00. 

A PRIMER OF CHEMISTRY. Including Analysis. By 
Arthur Vacher. 32mo. Cloth. Price 50 cents. 

COMMERCIAL ORGANIC ANALYSIS. Being a Treatise 
on the Properties, Proximate Analytical Examination, and Modes of 
Assaying the various Organic Chemicals and Preparations employed 
in the Arts, Manufactures, Medicine, etc. 8vo. Cloth. Price $3.50. 

MISCELLANEOUS. 

ON HOSPITALS AND PAYING WARDS throughout the 
World. Facts in Support of a Rearrangement of the System of Medi- . 
cal Relief. By Henry C. Burdett. 8vo. Cloth. Price $2.25. 

COTTAGE HOSPITALS ; Their Origin, Progress and Man- 
agement 2d edition, enlarged and illus. By Henry C. Burdett. $4.50. 

DEFECTS OF SIGHT AND HEARING; Their Nature, 
Causes and Prevention. By T. Wharton Jones, f.r.s. 2d edition. 
12mo. Cloth. Price 50 cents. 

IMPERFECT DIGESTION ; Its Causes and Treatment. By 
Arthur Leared, m.d., f.r.c.p. 6th edition. 12mo. Cloth. Price $1.50. 

COMPEND OF DOMESTIC MEDICINE, and Companion to 
the Medicine Chest. By Savory and Moore. Illustrated. 12mo. Cloth. 
Price 50 cents. 

HOW TO WORK WITH THE MICROSCOPE. A Com- 
plete Manual of Microscopical Manipulation. Containing full descrip- 
tions of all new processes of investigation, with directions for examining 
objects under the highest powers, and for photographing microscopical 
objects. By Lionel S. Beale, m.d. 5th edition, enlarged and containing 
over 400 illustrations, many being colored. 8vo. Cloth. Price $7.50. 

MICROSCOPIC MOUNTING. A Complete Manual, with 
notes on the collection and examination of objects. By Jno. H. Martin. 
2d edition. With 150 illustrations. 8vo. Cloth. Price $2.75. 

SECTION CUTTING. A Practical Guide to the Preparation 
and Mounting of Sections for the Microscope. By Sylvester Marsh. 
Illustrated. 16mo. Cloth. Price 75 cents. 

THE MICROSCOPE IN PRACTICAL MEDICINE. With 
full directions for examining, preparing and injecting objects, the vari- 
ous secretions, etc. By LioneL S. Beale, m.d. 4th edition. 500 illus- 
trations. 8vo. Cloth. Price $7.50. 

SEA AIR AND SEA BATHING ; Their Influence on Health. 
A G-uide for Visitors at the Seaside. By Chas. Parsons, m.d. 18ino. 
Cloth. Price 60 cents. 




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